Clubmd, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

CLUBMD, LLC

Practice address

1065 Ashley St
Suite 200
Bowling Green, KY 42103-3400

Phone

(270) 467-0010

NPI assigned

Aug 16, 2012

Organization subpart

Yes

Parent organization

CMD HOLDING, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Eric Warren Bletzinger

Title

Vice President

Phone

(270) 780-2825

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345075200000",
    "number": "1447508809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1094",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421021094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1065 ASHLEY ST",
            "address_2": "SUITE 200",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421033400",
            "telephone_number": "270-467-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUBMD, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CMD HOLDING, LLC",
        "enumeration_date": "2012-08-16",
        "last_updated": "2012-08-16",
        "status": "A",
        "authorized_official_last_name": "BLETZINGER",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "270-780-2825"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Primary Care Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.