Provider Demographics
NPI:1336241538
Name:TOTAL FITNESS CONNECTION,PLLC
Entity Type:Organization
Organization Name:TOTAL FITNESS CONNECTION,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS/CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-781-1151
Mailing Address - Street 1:2235 RUSSELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-5081
Mailing Address - Country:US
Mailing Address - Phone:270-781-1151
Mailing Address - Fax:
Practice Address - Street 1:2235 RUSSELLVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-5081
Practice Address - Country:US
Practice Address - Phone:270-781-1151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1225034945OtherNPI
KY1710983440OtherNPI
KY1043205024OtherNPI
KY1568421527OtherNPI
KY1760488480OtherNPI
KY1184620098OtherNPI