Organization
INTERVENTIONAL PAIN SPECIALISTS OF BOWLING GREEN, PLC
Active
Parent organization
INTERVENTIONAL PAIN SPECIALISTS OF BOWLING GREEN, PLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTERVENTIONAL PAIN SPECIALISTS OF BOWLING GREEN, PLC
Authorized official
ROBERT KEITH NORMAN CRNA (OWNER/PRESIDENT)
(270) 393-1912
Entity
Organization
Contact information
Practice address
1216 N RACE ST, GLASGOW, KY 42141-3462
(270) 651-7246
(270) 282-2027
Mailing address
350 PARK ST, STE 203B, BOWLING GREEN, KY 42101-1784
(270) 393-1912
(270) 393-1913
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7100062970
CRNA GROUP MEDICAID NUMBER
KY
05
—
7100063360
—
KY
05
—
7100097740
—
KY
05
—
7100152630
—
KY
Enumeration date
07/27/2015
Last updated
06/24/2022
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