Provider Demographics
NPI:1003900721
Name:DR JAMES R. RINNE M.D., PSC
Entity Type:Organization
Organization Name:DR JAMES R. RINNE M.D., PSC
Other - Org Name:DR. JAMES RINNE, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:RINNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-465-9237
Mailing Address - Street 1:1886 OLD LEBANON ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718
Mailing Address - Country:US
Mailing Address - Phone:270-465-9237
Mailing Address - Fax:270-465-9418
Practice Address - Street 1:1886 OLD LEBANON ROAD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718
Practice Address - Country:US
Practice Address - Phone:270-465-9237
Practice Address - Fax:270-465-9418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65927725Medicaid
KY65927725Medicaid
KY1636301Medicare ID - Type Unspecified