Provider Demographics
NPI:1205946951
Name:R RITCHIE VAN BUSSUM MD PSC
Entity type:Organization
Organization Name:R RITCHIE VAN BUSSUM MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RITCHIE
Authorized Official - Last Name:VAN BUSSUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-277-3636
Mailing Address - Street 1:1760 NICHOLASVILLE RD
Mailing Address - Street 2:STE 603
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1474
Mailing Address - Country:US
Mailing Address - Phone:859-277-2211
Mailing Address - Fax:859-277-7575
Practice Address - Street 1:1760 NICHOLASVILLE RD
Practice Address - Street 2:STE 603
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1474
Practice Address - Country:US
Practice Address - Phone:859-277-2211
Practice Address - Fax:859-277-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1437203395OtherNPI
KY6593431700Medicaid
KY1346390820OtherNPI
KY6422065000Medicaid
KY7890195600Medicaid
KY1144222399OtherNPI
KY1134123466OtherNPI
KY95001822Medicaid
KY0672501Medicare PIN
KY6725Medicare PIN
KY95001822Medicaid