Provider Demographics
NPI:1134320492
Name:MEDICAL SPECIALISTS OF CENTRAL KENTUCKY, P.S.C.
Entity Type:Organization
Organization Name:MEDICAL SPECIALISTS OF CENTRAL KENTUCKY, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:SHADOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-746-0440
Mailing Address - Street 1:PO BOX 51726
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-6726
Mailing Address - Country:US
Mailing Address - Phone:270-746-0440
Mailing Address - Fax:270-746-0882
Practice Address - Street 1:350 PARK ST
Practice Address - Street 2:SUITE 206
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1784
Practice Address - Country:US
Practice Address - Phone:270-746-0440
Practice Address - Fax:270-746-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26582207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000051271OtherBLUE CROSS BLUE SHIELD
KY65935504Medicaid
KY10806088OtherCAQH
KYCC3484OtherRR MEDICARE
KY1255438420OtherNPI FOR DR. R. SHADOWEN
KY65935504Medicaid
KY000000051271OtherBLUE CROSS BLUE SHIELD