Basic Information
| Provider Information | |||||||||
| NPI: | 1417927849 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOWLING GREEN FAMILY PHYSICIANS. INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1215 RIDGEWOOD DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434022690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193529071 | ||||||||
| FaxNumber: | 4193529073 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 RIDGEWOOD DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434022690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193529071 | ||||||||
| FaxNumber: | 4193529073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HORRIGAN | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4193529071 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2574209 | 05 | OH | MEDICAID | 07386013 | 01 | OH | AETNA INSURANCE | OTHER |