| Iris Medical Group Kentucky Llc | |
|
1131 Magnolia St Bowling Green KY 42103-2411 | |
| (615) 873-4490 | |
| Not Available |
| Full Name | Iris Medical Group Kentucky Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1131 Magnolia St, Bowling Green, Kentucky |
| Authorized Official Name and Position | Joel Parker (PRESIDENT) |
| Authorized Official Contact | 6158734490 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Iris Medical Group Kentucky Llc 330 Franklin Rd Ste 135-a270 Brentwood TN 37027-3280 Ph: (615) 873-4490 | Iris Medical Group Kentucky Llc 1131 Magnolia St Bowling Green KY 42103-2411 Ph: (615) 873-4490 |
| NPI Number | 1336908110 |
|---|---|
| Provider Enumeration Date | 03/15/2024 |
| Last Update Date | 03/15/2024 |
| Medicare PECOS PAC ID | 3971035064 |
|---|---|
| Medicare Enrollment ID | O20241014004226 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336908110 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Benjamin Aaron Dehaven |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497928824 PECOS PAC ID: 6901936244 Enrollment ID: I20100611000618 |
| Provider Name | Zuzanna Balfour |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588347330 PECOS PAC ID: 7012364185 Enrollment ID: I20241207000155 |
| Provider Name | Hailey Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952992810 PECOS PAC ID: 2567863889 Enrollment ID: I20241210002361 |
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