Basic Information
| Provider Information | |||||||||
| NPI: | 1205085495 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMONWEALTH HEALTH CORPORATION, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INPATIENT MEDICINE ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2697 | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421027697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707966540 | ||||||||
| FaxNumber: | 2707966576 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 PARK ST | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421011760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707966540 | ||||||||
| FaxNumber: | 2707966576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2008 | ||||||||
| LastUpdateDate: | 10/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | SOWELL | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2707451536 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 65931776 | 05 | KY | MEDICAID |