Basic Information
| Provider Information | |||||||||
| NPI: | 1417149733 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITALISTS AT GREENVIEW REGIONAL HOSPITAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 ASHLEY CIR | ||||||||
| Address2: | SUITE 535 | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421043362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707905550 | ||||||||
| FaxNumber: | 2707935351 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 ASHLEY CIR | ||||||||
| Address2: | SUITE 535 | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421043362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707905550 | ||||||||
| FaxNumber: | 2707935351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2007 | ||||||||
| LastUpdateDate: | 07/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | LOCKE | ||||||||
| AuthorizedOfficialFirstName: | CHUCK | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6153737600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 7100025250 | 05 | KY | MEDICAID |