Provider Demographics
NPI:1568960862
Name:COMMONWEALTH HEALTH CORPORATION, INC.
Entity Type:Organization
Organization Name:COMMONWEALTH HEALTH CORPORATION, INC.
Other - Org Name:MED CENTER HEALTH VEIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:SOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-745-1510
Mailing Address - Street 1:PO BOX 2697
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-7697
Mailing Address - Country:US
Mailing Address - Phone:270-796-3535
Mailing Address - Fax:270-467-2609
Practice Address - Street 1:825 2ND AVE STE B2
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1790
Practice Address - Country:US
Practice Address - Phone:270-796-3535
Practice Address - Fax:270-467-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty