Provider Demographics
NPI:1902380082
Name:RHEUMATOLOGY SPECIALISTS OF PADUCAH
Entity Type:Organization
Organization Name:RHEUMATOLOGY SPECIALISTS OF PADUCAH
Other - Org Name:PADUCAH RHEUMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-408-6105
Mailing Address - Street 1:100 KIANA CT STE B
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-6787
Mailing Address - Country:US
Mailing Address - Phone:270-408-6100
Mailing Address - Fax:270-408-6112
Practice Address - Street 1:100 KIANA CT STE B
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6787
Practice Address - Country:US
Practice Address - Phone:270-408-6100
Practice Address - Fax:270-408-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty