Provider Demographics
NPI:1497740997
Name:BOWLING GREEN DIALYSIS CENTER INC
Entity Type:Organization
Organization Name:BOWLING GREEN DIALYSIS CENTER INC
Other - Org Name:RAJAN KARALAKULASINGAM BOWLING GREEN KIDNEY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJANTHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARALAKULASINGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-458-6359
Mailing Address - Street 1:4114 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1534
Mailing Address - Country:US
Mailing Address - Phone:502-458-6359
Mailing Address - Fax:502-459-8626
Practice Address - Street 1:1834 LYDA AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3361
Practice Address - Country:US
Practice Address - Phone:270-782-1318
Practice Address - Fax:270-793-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY300032174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054740OtherANTHEM
KY39090048Medicaid
KY610939927OtherALL OTHER
KY182505Medicare Oscar/Certification
KY182505Medicare ID - Type Unspecified