Provider Demographics
NPI:1124058896
Name:BOWLING GREEN ANESTHESIOLOGY ASSOCIATES, PSC
Entity type:Organization
Organization Name:BOWLING GREEN ANESTHESIOLOGY ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-782-9994
Mailing Address - Street 1:PO BOX 2020
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-2020
Mailing Address - Country:US
Mailing Address - Phone:270-782-9994
Mailing Address - Fax:270-842-5048
Practice Address - Street 1:1725 ASHLEY CIR
Practice Address - Street 2:SUITE 209A
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3337
Practice Address - Country:US
Practice Address - Phone:270-782-9994
Practice Address - Fax:270-842-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65908048Medicaid
KYC30950Medicare PIN
KY2758Medicare ID - Type UnspecifiedMEDICARE GROUP