Provider Demographics
NPI:1841383353
Name:PADUCAH PHYSIATRIC PARTNERS P.S.C.
Entity Type:Organization
Organization Name:PADUCAH PHYSIATRIC PARTNERS P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROMMELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-443-9352
Mailing Address - Street 1:PO BOX 7038
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7038
Mailing Address - Country:US
Mailing Address - Phone:270-443-9352
Mailing Address - Fax:270-443-9013
Practice Address - Street 1:5150 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9060
Practice Address - Country:US
Practice Address - Phone:270-443-9352
Practice Address - Fax:270-443-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY208100000X, 363A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100103200Medicaid
KY65905606Medicaid
IL405786874Medicaid
KY65905606Medicaid