Provider Demographics
NPI:1417149733
Name:HOSPITALISTS AT GREENVIEW REGIONAL HOSPITAL LLC
Entity Type:Organization
Organization Name:HOSPITALISTS AT GREENVIEW REGIONAL HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7600
Mailing Address - Street 1:1801 ASHLEY CIR
Mailing Address - Street 2:SUITE 535
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3362
Mailing Address - Country:US
Mailing Address - Phone:270-790-5550
Mailing Address - Fax:270-793-5351
Practice Address - Street 1:1801 ASHLEY CIR
Practice Address - Street 2:SUITE 535
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3362
Practice Address - Country:US
Practice Address - Phone:270-790-5550
Practice Address - Fax:270-793-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100025250Medicaid
KY00418Medicare PIN
KYDG1928Medicare PIN