Organization
KENTUCKY MSO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA BOWMAN (PRESIDENT)
(615) 920-7000
Entity
Organization
Contact information
Practice address
1140 LEXINGTON RD, GEORGETOWN, KY 40324-9330
(855) 876-2412
(502) 570-5610
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7000
(615) 920-8775
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
2083X0100X
Occupational Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
2085R0001X
Radiation Oncology Physician
—
—
208600000X
Surgery Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
231H00000X
Audiologist
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K013930
MEDICARE
KY
Enumeration date
11/04/2013
Last updated
01/24/2024
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