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General NPI Number Information
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NPI Number | 1851277867
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Entity Type | Organization
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Legal Business Name | PAIN TREATMENT CENTER OF THE BLUEGRASS PSC
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 2416 REGENCY RD
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City | LEXINGTON
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State | KY
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Zip | 40503-2954
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Country | US
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Telephone | 317-706-7246
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Fax | 317-706-3417
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Provider Business Mailing Address
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Address Line | PO BOX 737100
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City | CHICAGO
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State | IL
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Zip | 60673-6374
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Country | US
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Telephone | 317-706-7246
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Fax | 317-706-3417
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD KOWLOWITZ
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Credential | MD
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Telephone | 317-409-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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