NPIMap

Organization Active NPI

Western Kentucky University Sports Medicine

  • Student Health Clinic/Center
  • Bowling Green, KY
National Provider Identifier
1790075273
Registry record updated Apr 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student Health Clinic/CenterTaxonomy code 261QS1000X
Legal business name
WESTERN KENTUCKY UNIVERSITY SPORTS MEDICINE
Practice address
1605 Avenue of Champions
RM 128
Bowling Green, KY 42101-6412
Phone
(972) 687-1877
Fax
(972) 367-3434
NPI assigned
Apr 18, 2011
Last updated
Apr 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2011

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

Authorized official

Name
Mr. Bill Edwards, ATC, MA
Title
Director of Sports Medicine
Phone
(270) 745-6026

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student Health Clinic/Center 261QS1000X Primary

Addresses

Primary practice location

1605 Avenue of Champions
RM 128
Bowling Green, KY 42101-6412

Mailing address

PO Box 819020
Dallas, TX 75381-9020
Phone (972) 687-1877

National Provider Directory

National Provider Directory
Tax ID family
Western Kentucky University Sports Medicine5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1605 Avenue of Champions
Rm 128
Bowling Green, KY 42101
Phone (972) 687-1877

NPI Registry JSON

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

{
    "created_epoch": "1303084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303084800000",
    "number": "1790075273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 819020",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753819020",
            "telephone_number": "972-687-1877",
            "fax_number": "972-367-3434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 AVENUE OF CHAMPIONS",
            "address_2": "RM 128",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421016412",
            "telephone_number": "972-687-1877",
            "fax_number": "972-367-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN KENTUCKY UNIVERSITY SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-18",
        "last_updated": "2011-04-18",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "BILL",
        "authorized_official_title_or_position": "DIRECTOR OF SPORTS MEDICINE",
        "authorized_official_telephone_number": "270-745-6026",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ATC, MA"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2011; 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.