Provider Demographics
NPI:1467708180
Name:PARK STREET PARTNERS, L.L.P.
Entity Type:Organization
Organization Name:PARK STREET PARTNERS, L.L.P.
Other - Org Name:CORPCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE-PRESIDENT
Authorized Official - Prefix:MR
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 1:1110 WILKINSON TRCE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-3402
Mailing Address - Country:US
Mailing Address - Phone:270-796-3590
Mailing Address - Fax:270-745-1156
Practice Address - Street 1:1110 WILKINSON TRCE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3402
Practice Address - Country:US
Practice Address - Phone:270-796-3590
Practice Address - Fax:270-745-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYXXXXXXXXXX261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health