Provider Demographics
NPI:1285930834
Name:CENTRAL KENTUCKY MOBILITY OF BOWLING GREEN, LLC
Entity type:Organization
Organization Name:CENTRAL KENTUCKY MOBILITY OF BOWLING GREEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-225-3624
Mailing Address - Street 1:1050 ENTERPRISE DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40510-1016
Mailing Address - Country:US
Mailing Address - Phone:859-225-3624
Mailing Address - Fax:859-225-3682
Practice Address - Street 1:1017 SHIVE LN
Practice Address - Street 2:SUITE E
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-8039
Practice Address - Country:US
Practice Address - Phone:270-904-4934
Practice Address - Fax:270-904-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies