Provider Demographics
NPI:1891799177
Name:ROSE BOWLING, LLC
Entity Type:Organization
Organization Name:ROSE BOWLING, LLC
Other - Org Name:MADISON FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:REBA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-626-7794
Mailing Address - Street 1:2161 LEXINGTON RD
Mailing Address - Street 2:FIRST FLOOR, SUITE 5
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7952
Mailing Address - Country:US
Mailing Address - Phone:859-626-7794
Mailing Address - Fax:859-626-7764
Practice Address - Street 1:2161 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7952
Practice Address - Country:US
Practice Address - Phone:859-626-7794
Practice Address - Fax:859-626-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900185261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001775Medicaid
KY35001775Medicaid
KY9299Medicare PIN