Provider Demographics
NPI:1992013114
Name:COMMONWEALTH HEALTH CORPORATION, INC.
Entity Type:Organization
Organization Name:COMMONWEALTH HEALTH CORPORATION, INC.
Other - Org Name:MED CENTER HEALTH ENT
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:G
Authorized Official - Last Name:SOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-745-1500
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:270-782-7768
Mailing Address - Fax:270-781-9480
Practice Address - Street 1:421 US 31W BYP
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1775
Practice Address - Country:US
Practice Address - Phone:270-782-7768
Practice Address - Fax:270-781-9480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100331660Medicaid
KY65931776Medicaid
KY78900743Medicaid
KY65931776Medicaid