OWENSBORO HEALTH MEDICAL GROUP INC

Provider Demographics

• NPI: 1265747752
• Name: OWENSBORO HEALTH MEDICAL GROUP INC
• Entity type: Organization
• Organization Name: OWENSBORO HEALTH MEDICAL GROUP INC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: SECRETARY
• Authorized Official - First Name: RUSSELL
• Authorized Official - Middle Name: S
• Authorized Official - Last Name: RANALLO
• Authorized Official - Phone: 270-685-7180
• Mailing Address - Street 1: PO BOX 23229
• Mailing Address - City: OWENSBORO
• Mailing Address - State: KY
• Mailing Address - Zip Code: 42304-3229
• Mailing Address - Country: US
• Mailing Address - Phone: 270-688-1330
• Mailing Address - Fax: 270-688-1338
• Practice Address - Street 1: 1301 PLEASANT VALLEY RD STE 401
• Practice Address - City: OWENSBORO
• Practice Address - State: KY
• Practice Address - Zip Code: 42303-9774
• Practice Address - Country: US
• Practice Address - Phone: 270-417-7800
• Practice Address - Fax: 270-417-7809
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2010-08-09
• Last Update Date: 2025-05-19

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207RG0100X	Allopathic & Osteopathic Physicians	Internal Medicine	Gastroenterology	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Medical	Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	363LA2100X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Acute Care	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LP2300X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Primary Care	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KY	7100197540	Medicaid
IN	200135730	Medicaid
IN	200135730	Medicaid
IN	249390	Medicare PIN