1700989217 NPI number — BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION

Table of content: (NPI 1700989217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700989217 NPI number — BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE MEDICAL CENTER AT SCOTTSVILLE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700989217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
456 BURNLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42164-6355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-622-2846
Provider Business Mailing Address Fax Number:
270-622-2811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
456 BURNLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-622-2846
Provider Business Practice Location Address Fax Number:
270-622-2811
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOWELL
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
EXEC. VICE PRESIDENT
Authorized Official Telephone Number:
270-745-1500

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  P05202 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: P05202 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: P05202 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: P05202 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: P05202 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12503116 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54032743 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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