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General NPI Number Information
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NPI Number | 1295865368
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Entity Type | Organization
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Legal Business Name | BOWLING GREEN PEDIATRICS, INCORPORATED
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1300 ANDREA ST SUITE 205
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3382
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Country | US
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Telephone | 270-793-9930
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Fax | 270-793-9112
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Provider Business Mailing Address
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Address Line | 1300 ANDREA ST SUITE 205
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3382
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Country | US
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Telephone | 270-793-9930
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Fax | 270-793-9112
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY LEE BITTERLING
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Credential | M.D.
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Telephone | 270-793-9930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 33335
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License Number State | KY
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