Provider Demographics
NPI:1336268234
Name:BOWLING GREEN WARREN COUNTY PRIMARY CARE CENTER, INC.
Entity Type:Organization
Organization Name:BOWLING GREEN WARREN COUNTY PRIMARY CARE CENTER, INC.
Other - Org Name:FAIRVIEW COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTINGHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-783-3573
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-1177
Mailing Address - Country:US
Mailing Address - Phone:270-783-3573
Mailing Address - Fax:270-783-4081
Practice Address - Street 1:225 NATCHEZ TRACE AVENUE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7995
Practice Address - Country:US
Practice Address - Phone:270-783-3573
Practice Address - Fax:270-783-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700042261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000680Medicaid
KYX61497Medicare UPIN
KY181863Medicare PIN
KY31000680Medicaid
KY18-1880Medicare PIN