| NPI | 1053782193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL S RANALLO Secretary 270-685-7180 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2025-02-19 |