Organization
BOWLING GREEN EMERGENCY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J BUNKER (CHAIRMAN/PRESIDENT/CEO)
(904) 805-1300
Entity
Organization
Contact information
Practice address
1801 ASHLEY CIR, BOWLING GREEN, KY 42104-3362
(270) 793-1000
(904) 805-1302
Mailing address
PO BOX 758749, BALTIMORE, MD 21275-0001
(904) 805-1300
(904) 805-1302
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1172493
PASSPORT HEALTH PLAN
KY
01
—
610070900
DEPT OF LABOR
KY
05
—
65920696
—
KY
01
—
DD4880
RAIL ROAD MEDICARE
KY
Enumeration date
05/03/2006
Last updated
07/23/2008
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