Provider Demographics
NPI:1235166083
Name:RANKIN, WADE M (DO)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:M
Last Name:RANKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:WADE
Other - Middle Name:
Other - Last Name:RANKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1701 MERCY HEALTH PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-6147
Mailing Address - Country:US
Mailing Address - Phone:513-952-4590
Mailing Address - Fax:
Practice Address - Street 1:1551 AUGUSTA CHATHAM RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KY
Practice Address - Zip Code:41002-9224
Practice Address - Country:US
Practice Address - Phone:606-756-2117
Practice Address - Fax:606-756-2135
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008447207Q00000X
KY03153207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2605149Medicaid
KY7100070340Medicaid
KY7100070340Medicaid
KY0055665Medicare PIN
OH4158917Medicare PIN