| NPI | 1891158119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL S RANALLO Secretary 270-417-4813 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 1041C0700X Social Worker Clinical | |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 207VM0101X Obstetrics & Gynecology Maternal & Fetal Medicine | |
| 207X00000X Orthopaedic Surgery | |
| 213ES0103X Podiatrist Foot & Ankle Surgery | |
| 363A00000X Physician Assistant | |
| 363AS0400X Physician Assistant Surgical | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2022-12-28 |