Provider Demographics
NPI:1013234863
Name:BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION
Other - Org Name:FOUNTAIN RUN RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAWLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-745-1500
Mailing Address - Street 1:PO BOX 3560
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-3560
Mailing Address - Country:US
Mailing Address - Phone:270-434-4857
Mailing Address - Fax:270-434-4957
Practice Address - Street 1:47 AKERSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN RUN
Practice Address - State:KY
Practice Address - Zip Code:42133-7910
Practice Address - Country:US
Practice Address - Phone:270-434-4857
Practice Address - Fax:270-434-4957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900080261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100154270Medicaid