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General NPI Number Information
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NPI Number | 1336908110
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Entity Type | Organization
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Legal Business Name | IRIS MEDICAL GROUP KENTUCKY LLC
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 1131 MAGNOLIA ST
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City | BOWLING GREEN
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State | KY
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Zip | 42103-2411
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Country | US
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Telephone | 615-873-4490
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Fax |
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Provider Business Mailing Address
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Address Line | 330 FRANKLIN RD STE 135-A270
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City | BRENTWOOD
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State | TN
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Zip | 37027-3280
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Country | US
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Telephone | 615-873-4490
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOEL PARKER
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Credential | MD
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Telephone | 615-873-4490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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