Provider Demographics
NPI:1275530008
Name:HANNAH, RANCIE WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:RANCIE
Middle Name:WAYNE
Last Name:HANNAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SAINT CHRISTOPHER DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7087
Mailing Address - Country:US
Mailing Address - Phone:606-836-3196
Mailing Address - Fax:606-836-2564
Practice Address - Street 1:1101 SAINT CHRISTOPHER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7087
Practice Address - Country:US
Practice Address - Phone:606-836-3196
Practice Address - Fax:606-836-2564
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000199568OtherBLUE CROSS BLUE SHIELD
KY64044704Medicaid
OH2204836Medicaid
OHHA0897823Medicare ID - Type UnspecifiedOH MEDICARE
000000199568OtherBLUE CROSS BLUE SHIELD
H08666Medicare UPIN
KY64044704Medicaid