# OWENSBORO HEALTH MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OWENSBORO HEALTH, INC
- **Other names:** Owensboro Health Medical Group-Family and Sports Medicine
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1912594334
- **Legal business name:** OWENSBORO HEALTH, INC
- **Authorized official:** RUSSELL S RANALLO (SECRETARY)
- **Authorized official phone:** (270) 417-4813

## Contact information

- **Practice address:** 908 WALLACE AVE STE 103, LEITCHFIELD, KY 42754-1479
- **Practice address phone:** (270) 230-0124
- **Mailing address:** PO BOX 23229, OWENSBORO, KY 42304-3229

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 12/31/2020
- **Last updated:** 12/28/2022