Provider Demographics
NPI:1750972733
Name:SOUTHERN KENTUCKY MOBILE MEDICAL SERVICES
Entity type:Organization
Organization Name:SOUTHERN KENTUCKY MOBILE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:CCMA
Authorized Official - Phone:270-780-6250
Mailing Address - Street 1:746 STEEPLECHASE WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7990
Mailing Address - Country:US
Mailing Address - Phone:270-780-6250
Mailing Address - Fax:
Practice Address - Street 1:746 STEEPLECHASE WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7990
Practice Address - Country:US
Practice Address - Phone:270-780-6250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty