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2211 Mayfair Dr Suite 409 Owensboro KY 42301 | |
| (270) 417-7980 | |
| (270) 417-7989 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 2211 Mayfair Dr, Owensboro, Kentucky |
| Authorized Official Name and Position | Russell S Ranallo (SECRETARY) |
| Authorized Official Contact | 2704174813 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 23229 Owensboro KY 42304-3229 Ph: (270) 688-1330 | 2211 Mayfair Dr Suite 409 Owensboro KY 42301 Ph: (270) 417-7980 |
| NPI Number | 1013353101 |
|---|---|
| Provider Enumeration Date | 05/15/2013 |
| Last Update Date | 09/19/2022 |
| Certification Date | 09/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013353101 | NPI | - | NPPES |
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