Basic Information
| Provider Information | |||||||||
| NPI: | 1538145172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOVETT | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1791 ASHLEY CIR | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421043339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707814090 | ||||||||
| FaxNumber: | 2708423133 | ||||||||
| Practice Location | |||||||||
| Address1: | 1791 ASHLEY CIR | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421043339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707814090 | ||||||||
| FaxNumber: | 2708423133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 12/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 18648 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0000053945 | 01 | KY | BLUE CROSS BLUE SHIELD | OTHER | CH4189 | 01 | KY | RAILROAD MEDICARE | OTHER |