Provider Demographics
NPI:1609878768
Name:MCINTOSH, RITA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:L
Last Name:MCINTOSH
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1532 LONE OAK RD STE 230
Mailing Address - Street 2:KENTUCKY SPINE & BRAIN
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003
Mailing Address - Country:US
Mailing Address - Phone:270-538-5800
Mailing Address - Fax:270-538-5801
Practice Address - Street 1:1532 LONE OAK RD STE 230
Practice Address - Street 2:KENTUCKY SPINE & BRAIN
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-538-5800
Practice Address - Fax:270-538-5801
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2008-09-03
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Provider Licenses
StateLicense IDTaxonomies
KYPA878363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000517568OtherANTHEM
KYQ38175Medicare UPIN
KY0795804Medicare PIN
KY1273708Medicare PIN