Healthcare Provider Details

I. General information

NPI: 1841383353
Provider Name (Legal Business Name): PADUCAH PHYSIATRIC PARTNERS P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 VILLAGE SQUARE DR
PADUCAH KY
42001-9060
US

IV. Provider business mailing address

PO BOX 7038
PADUCAH KY
42002-7038
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-9352
  • Fax: 270-443-9013
Mailing address:
  • Phone: 270-443-9352
  • Fax: 270-443-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateKY

VIII. Authorized Official

Name: DR. MONTE E ROMMELMAN
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 270-443-9352