Provider Demographics
NPI:1457779795
Name:COMMONWEALTH HEALTH CORPORATION, INC
Entity Type:Organization
Organization Name:COMMONWEALTH HEALTH CORPORATION, INC
Other - Org Name:INFECTIOUS DISEASE AND TRAVEL MEDICINE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC. VICE PRESIDENT / CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-796-5591
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:270-780-2760
Mailing Address - Fax:270-780-2761
Practice Address - Street 1:720 2ND AVE STE 307
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1718
Practice Address - Country:US
Practice Address - Phone:270-780-2760
Practice Address - Fax:270-780-2761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65931776Medicaid
KY65931776Medicaid
KY78900743Medicaid