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General NPI Number Information
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NPI Number | 1043604168
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Entity Type | Organization
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Legal Business Name | OWENSBORO HEALTH MEDICAL GROUP INC
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 1000 BRECKENRIDGE ST SUITE 205
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City | OWENSBORO
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State | KY
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Zip | 42303-0839
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Country | US
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Telephone | 270-688-3550
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Fax | 270-688-3559
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Provider Business Mailing Address
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Address Line | PO BOX 23229
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City | OWENSBORO
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State | KY
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Zip | 42304-3229
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Country | US
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Telephone | 270-688-1330
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Fax | 270-688-1338
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Authorized Official
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Title or Position | SECRETARY
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Name | RUSSELL S RANALLO
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Credential |
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Telephone | 270-417-4813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State | KY
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