Provider Demographics
NPI:1558132498
Name:OWENSBORO HEALTH MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:OWENSBORO HEALTH MEDICAL GROUP, INC.
Other - Org Name:OWENSBORO HEALTH MEDICAL GROUP - NEUROSURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY-CFO
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:RANALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-685-7180
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
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 1:2200 E PARRISH AVE STE 101C
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1450
Practice Address - Country:US
Practice Address - Phone:270-688-1650
Practice Address - Fax:270-688-1651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OWENSBORO HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-10
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty