Provider Demographics
NPI:1710918412
Name:RAMAGE, TERRI LEE
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LEE
Last Name:RAMAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 TYREE RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-9646
Mailing Address - Country:US
Mailing Address - Phone:270-898-1819
Mailing Address - Fax:270-898-6605
Practice Address - Street 1:220 TYREE RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-9646
Practice Address - Country:US
Practice Address - Phone:270-898-1819
Practice Address - Fax:270-898-6605
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY253288332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000340914OtherANTHEM
KY90008517Medicaid
KY4848660001Medicare ID - Type Unspecified