Provider Demographics
NPI:1194833848
Name:ANDERSON & BOWLDS PLLC
Entity Type:Organization
Organization Name:ANDERSON & BOWLDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-348-5588
Mailing Address - Street 1:118 PATRIOT DRIVE
Mailing Address - Street 2:#203
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004
Mailing Address - Country:US
Mailing Address - Phone:502-348-5588
Mailing Address - Fax:502-348-1046
Practice Address - Street 1:118 PATRIOT DRIVE
Practice Address - Street 2:#203
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-348-5588
Practice Address - Fax:502-348-1046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64208440Medicaid
KY64051675Medicaid
0931702Medicare ID - Type Unspecified
0931701Medicare ID - Type Unspecified
KY64208440Medicaid
KY64051675Medicaid