MEDICARE: BOWLING GREEN-WARREN COUNTY COMMUNITY HOSPITAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	103TC0700X	Clinical Psychologist	KY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	KY
3	1041C0700X	Clinical Social Worker	KY
4	2084P0800X	Psychiatry Physician	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000928950	OTHER	KY	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184016123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOWLING GREEN-WARREN COUNTY COMMUNITY HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 117924
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-7924
Country	:	US
Telephone Number	:	270-843-5103
Fax Number	:	270-843-5104

Provider Business Practice Location Address
First Line	:	350 PARK ST
Second Line	:	204
City	:	BOWLING GREEN
State	:	KY
Zip	:	42101-1784
Country	:	US
Telephone Number	:	270-843-5103
Fax Number	:	270-843-5104

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT / CFO
Name	:	MICHELE LAWLESS
Credential	:
Telephone Number	:	270-745-1500

Provider Enumeration Date	:	02/27/2015
Last Update Date	:	06/06/2026

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