MEDICARE: WESTERN KENTUCKY UNIVERSITY RESEARCH FOUNDATION, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1669506762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN KENTUCKY UNIVERSITY RESEARCH FOUNDATION, INC.

Provider Business Mailing Address
First Line	:	1906 COLLEGE HEIGHTS BLVD # 11016
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42101-1000
Country	:	US
Telephone Number	:	270-745-4652
Fax Number	:	270-745-4211

Provider Business Practice Location Address
First Line	:	1906 COLLEGE HEIGHTS BLVD
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42101-1000
Country	:	US
Telephone Number	:	270-745-4125
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF ADMINISTRATION
Name	:	DR. PHILLIP EARL MYERS
Credential	:	PH.D.
Telephone Number	:	270-745-4652

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	08/22/2020

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