Provider Demographics
NPI:1033313390
Name:WILLIAM F MARRS
Entity Type:Organization
Organization Name:WILLIAM F MARRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FAUNUS
Authorized Official - Last Name:MARRS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-651-6707
Mailing Address - Street 1:511 N RACE ST
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2913
Mailing Address - Country:US
Mailing Address - Phone:270-651-6707
Mailing Address - Fax:270-651-1751
Practice Address - Street 1:511 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2913
Practice Address - Country:US
Practice Address - Phone:270-651-6707
Practice Address - Fax:270-651-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78001591Medicaid
KY64177825Medicaid
KY64177825Medicaid
KYS35590Medicare UPIN
KY3881Medicare ID - Type Unspecified