OWENSBORO HEALTH MEDICAL GROUP, INC

Provider Demographics

• NPI: 1376594242
• Name: OWENSBORO HEALTH MEDICAL GROUP, INC
• Entity Type: Organization
• Organization Name: OWENSBORO HEALTH MEDICAL GROUP, INC
• Other - Org Name: OWENSBORO HEALTH MEDICAL GROUP - RHEUMATOLOGY
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: SECRETARY
• Authorized Official - Prefix: MR
• Authorized Official - First Name: RUSSELL
• Authorized Official - Middle Name: S
• Authorized Official - Last Name: RANALLO
• Authorized Official - Phone: 270-417-4813
• Mailing Address - Street 1: PO BOX 23229
• Mailing Address - City: OWENSBORO
• Mailing Address - State: KY
• Mailing Address - Zip Code: 42304-3229
• Mailing Address - Country: US
• Mailing Address - Phone: 270-688-1330
• Mailing Address - Fax: 270-688-1338
• Practice Address - Street 1: 2211 MAYFAIR DR STE 101
• Practice Address - City: OWENSBORO
• Practice Address - State: KY
• Practice Address - Zip Code: 42301
• Practice Address - Country: US
• Practice Address - Phone: 270-688-1352
• Practice Address - Fax: 270-683-4313
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: OWENSBORO HEALTH INC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-05-15
• Last Update Date: 2022-12-07

Provider Licenses

State	License ID	Taxonomies
		101YP2500X, 1041C0700X, 363L00000X
KY		207P00000X, 207Q00000X, 207R00000X, 207RC0000X, 207RC0001X, 207RI0011X, 207RP1001X, 207RR0500X, 208000000X, 2083X0100X, 363A00000X, 363LF0000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	101YP2500X	Behavioral Health & Social Service Providers	Counselor	Professional	Group - Multi-Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty
No	207P00000X	Allopathic & Osteopathic Physicians	Emergency Medicine		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207RC0000X	Allopathic & Osteopathic Physicians	Internal Medicine	Cardiovascular Disease	Group - Multi-Specialty
No	207RC0001X	Allopathic & Osteopathic Physicians	Internal Medicine	Clinical Cardiac Electrophysiology	Group - Multi-Specialty
No	207RI0011X	Allopathic & Osteopathic Physicians	Internal Medicine	Interventional Cardiology	Group - Multi-Specialty
No	207RP1001X	Allopathic & Osteopathic Physicians	Internal Medicine	Pulmonary Disease	Group - Multi-Specialty
No	207RR0500X	Allopathic & Osteopathic Physicians	Internal Medicine	Rheumatology	Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	2083X0100X	Allopathic & Osteopathic Physicians	Preventive Medicine	Occupational Medicine	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KY	000000059970	Other	BC -TELLCITY/PPCC/CCARE
KY	000000519327	Other	BCBS PIN # WKRC LOCATION
KY	7100087350	Medicaid
KY	7100109220	Medicaid
KY	7100183670	Medicaid
KY	000000544935	Other	BCBS # OMHS PALLIATIVE CARE
IN	200135730	Medicaid
IN	200135730E	Medicaid
KY	7100000880	Medicaid
KY	7100080250	Medicaid
KY	000000568006	Other	BCBS COOP HEALTH
KY	7100105410	Medicaid
KY	7100110510	Medicaid
KY	7100232290	Medicaid
KY	6592789900	Medicaid
KY	7100082820	Medicaid
KY	7100100440	Medicaid
KY	000000618767	Other	BCBS # MULTICARE OHIO COUNTY
KY	7100142180	Medicaid
KY	7100008190	Medicaid
KY	7100106010	Medicaid
KY	7100108820	Medicaid
KY	7100140340	Medicaid
KY	000000475394	Other	BCBS PIN MULTICARE CLINIC
KY	7100100470	Medicaid
IN	249390	Medicare PIN