Organization
PADUCAH PRIMARY CARE, P.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD L WILSON M.D. (PRESIDENT)
(270) 442-8575
Entity
Organization
Contact information
Practice address
4620 VILLAGE SQUARE DR, PADUCAH, KY 42001-7501
(270) 442-8575
(270) 442-8783
Mailing address
2601 KENTUCKY AVE, SUITE 101, PADUCAH, KY 42003-3817
(270) 442-8575
(270) 442-8783
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65927717
—
KY
Enumeration date
01/31/2007
Last updated
10/21/2019
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