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General NPI Number Information
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NPI Number | 1760411342
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Entity Type | Organization
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Legal Business Name | BLUEGRASS OUTPATIENT CENTER OF BOWLING GREEN, L.L.C.
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 1751 SCOTTSVILLE RD STE 9
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3357
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Country | US
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Telephone | 270-796-6850
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Fax | 270-781-8228
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Provider Business Mailing Address
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Address Line | PO BOX 9961
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City | BOWLING GREEN
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State | KY
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Zip | 42102-4961
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Country | US
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Telephone | 270-745-1100
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Fax | 270-745-1156
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MICHELE W LAWLESS
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Credential |
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Telephone | 270-745-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 100615
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License Number State | KY
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