Provider Demographics
NPI:1295865368
Name:BOWLING GREEN PEDIATRICS, INCORPORATED
Entity Type:Organization
Organization Name:BOWLING GREEN PEDIATRICS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BITTERLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-793-9930
Mailing Address - Street 1:1300 ANDREA ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3382
Mailing Address - Country:US
Mailing Address - Phone:270-793-9930
Mailing Address - Fax:270-793-9112
Practice Address - Street 1:1300 ANDREA ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3382
Practice Address - Country:US
Practice Address - Phone:270-793-9930
Practice Address - Fax:270-793-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33335208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty