Provider Demographics
NPI:1831103696
Name:COWLES CLINIC SERVICES, LLC
Entity Type:Organization
Organization Name:COWLES CLINIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-454-0027
Mailing Address - Street 1:1000 COWLES CLINC WAY
Mailing Address - Street 2:SUITE A-400
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-5285
Mailing Address - Country:US
Mailing Address - Phone:706-454-0027
Mailing Address - Fax:
Practice Address - Street 1:1000 COWLES CLINC WAY
Practice Address - Street 2:SUITE P-100
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-5285
Practice Address - Country:US
Practice Address - Phone:706-454-0036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology