1649359514 NPI number — MARCIA D EBBS MD PSC

Table of content: MARCIA D EBBS MD PSC (NPI 1649359514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649359514 NPI number — MARCIA D EBBS MD PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EBBS
Provider First Name:
MARCIA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1649359514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1006 NEW MOODY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANGE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40031-9122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-593-0083
Provider Business Mailing Address Fax Number:
502-222-0029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1006 NEW MOODY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-9122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-593-0083
Provider Business Practice Location Address Fax Number:
502-222-0029
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  30727 , 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: 0100865 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64307275 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000052153D . This is a "HUMANA - NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 118157 . This is a "SIHO - NICC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50027441 . This is a "PASSPORT - NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 019456 . This is a "SIHO - NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6935264 . This is a "CIGNA - NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000644690 . This is a "ANTHEM - NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000675746 . This is a "ANTHEM - NICC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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