Organization
INTERVENTIONAL PAIN SPECIALISTS OF BOWLING GREEN PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT KEITH NORMAN CRNA (OWNER/PRESIDENT)
(270) 393-1912
Entity
Organization
Contact information
Practice address
165 NATCHEZ TRACE AVE, SUITE 205, BOWLING GREEN, KY 42103-7940
(270) 393-1912
(270) 393-1913
Mailing address
165 NATCHEZ TRACE AVE, SUITE 205, BOWLING GREEN, KY 42103-7940
(270) 393-1912
(270) 393-1913
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
KY
207L00000X
Anesthesiology Physician
—
KY
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
KY
208VP0000X
Pain Medicine Physician
—
KY
208VP0014X
Interventional Pain Medicine Physician
—
KY
363L00000X
Nurse Practitioner
—
KY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
367500000X
Certified Registered Nurse Anesthetist
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7100062970
CRNA GROUP MCD NUMBER
KY
05
—
7100063360
—
KY
05
—
7100097740
—
KY
05
—
7100152630
—
KY
Enumeration date
01/09/2009
Last updated
07/21/2022
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