1053508663 NPI number — MICHAEL G. EHRIE, JR, PSC

Table of content: (NPI 1053508663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053508663 NPI number — MICHAEL G. EHRIE, JR, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL G. EHRIE, JR, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053508663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 SAINT CHRISTOPHER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41101-7055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-836-9622
Provider Business Mailing Address Fax Number:
606-836-1986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 SAINT CHRISTOPHER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-7055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-836-9622
Provider Business Practice Location Address Fax Number:
606-836-1986
Provider Enumeration Date:
09/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EHRIE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
606-836-9622

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  21309 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010000406 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 020394400 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0476373 . This is a "OHIO MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 64213093 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4460420 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000047402 . This is a "ANTHEM/BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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