Basic Information
| Provider Information | |||||||||
| NPI: | 1679629463 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BYRAM N RATLIFF II MD PSC | ||||||||
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| OtherOrganizationName: | BYRAM NEWTON RATLIFF II MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 STERLING AVE | ||||||||
| Address2: | |||||||||
| City: | MT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403531139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594982323 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 STERLING AVE | ||||||||
| Address2: | |||||||||
| City: | MT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403531139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594982323 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 12/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | RATLIFF | ||||||||
| AuthorizedOfficialFirstName: | BYRAM | ||||||||
| AuthorizedOfficialMiddleName: | NEWTON | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8594982323 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 25074 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 65921363 | 05 | KY | MEDICAID | 30B7 | 01 | KY | BLUE CROSS BLUE SHIELD | OTHER |