Provider Demographics
NPI:1245371632
Name:ALLERGY CARE BOWLING GREEN INC
Entity type:Organization
Organization Name:ALLERGY CARE BOWLING GREEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-781-1586
Mailing Address - Street 1:1724 ROCKINGHAM AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3379
Mailing Address - Country:US
Mailing Address - Phone:270-842-7588
Mailing Address - Fax:
Practice Address - Street 1:1724 ROCKINGHAM AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3379
Practice Address - Country:US
Practice Address - Phone:270-842-7588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22507207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CM6973OtherRAILROAD MEDICARE
KY7100010380Medicaid
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