Provider Demographics
NPI:1538455415
Name:COMMONWEALTH HEALTH CORPORATION, INC
Entity type:Organization
Organization Name:COMMONWEALTH HEALTH CORPORATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:SOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-745-1500
Mailing Address - Street 1:PO BOX 2697
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-7697
Mailing Address - Country:US
Mailing Address - Phone:270-745-1100
Mailing Address - Fax:270-745-1156
Practice Address - Street 1:825 2ND AVE
Practice Address - Street 2:SUITE C3
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1786
Practice Address - Country:US
Practice Address - Phone:270-780-2660
Practice Address - Fax:270-780-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY363LF0000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65931776Medicaid
KY7011Medicare PIN