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General NPI Number Information
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NPI Number | 1851582688
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Entity Type | Organization
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Legal Business Name | MY PRIVATE MD PSC
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 175 S ENGLISH STATION RD
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City | LOUISVILLE
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State | KY
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Zip | 40245-4160
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Country | US
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Telephone | 502-253-6582
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Fax | 502-253-6585
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Provider Business Mailing Address
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Address Line | 175 S ENGLISH STATION RD
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City | LOUISVILLE
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State | KY
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Zip | 40245-4160
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Country | US
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Telephone | 502-253-6582
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Fax | 502-253-6585
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS PRATHER RANKIN
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Credential | M.D.
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Telephone | 502-253-6582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 19902
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License Number State | MH
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