Provider Demographics
NPI:1205346210
Name:INTERVENTIONAL PAIN SPECIALISTS OF BOWLING GREEN, PLC
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN SPECIALISTS OF BOWLING GREEN, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:270-393-1912
Mailing Address - Street 1:165 NATCHEZ TRACE AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7947
Mailing Address - Country:US
Mailing Address - Phone:270-745-7246
Mailing Address - Fax:270-282-2027
Practice Address - Street 1:1112 S MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-2371
Practice Address - Country:US
Practice Address - Phone:270-745-7246
Practice Address - Fax:270-282-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty