| Premise Health Of West Virginia Medical, Medical Corporation | |
|
381 Southwood Court Bowling Green KY 42101-7513 | |
| (279) 793-5390 | |
| (279) 493-5396 |
| Full Name | Premise Health Of West Virginia Medical, Medical Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 381 Southwood Court, Bowling Green, Kentucky |
| Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premise Health Of West Virginia Medical, Medical Corporation 5500 Maryland Way Ste 120 Brentwood TN 37027-4993 Ph: () - | Premise Health Of West Virginia Medical, Medical Corporation 381 Southwood Court Bowling Green KY 42101-7513 Ph: (279) 793-5390 |
| NPI Number | 1144633892 |
|---|---|
| Provider Enumeration Date | 06/10/2014 |
| Last Update Date | 08/15/2022 |
| Medicare PECOS PAC ID | 9133341464 |
|---|---|
| Medicare Enrollment ID | O20141120001962 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144633892 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Thomas Houston Vogler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194097105 PECOS PAC ID: 0840454427 Enrollment ID: I20120611000686 |
| Provider Name | Lena M Gokey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942540018 PECOS PAC ID: 3375789738 Enrollment ID: I20130410000142 |
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