Provider Demographics
NPI:1053508663
Name:MICHAEL G. EHRIE, JR, PSC
Entity Type:Organization
Organization Name:MICHAEL G. EHRIE, JR, PSC
Other - Org Name:MICHAEL G. EHRIE, MD. PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:EHRIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:606-836-9622
Mailing Address - Street 1:1150 SAINT CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7055
Mailing Address - Country:US
Mailing Address - Phone:606-836-9622
Mailing Address - Fax:606-836-1986
Practice Address - Street 1:1150 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7055
Practice Address - Country:US
Practice Address - Phone:606-836-9622
Practice Address - Fax:606-836-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21309302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY010000406OtherRAILROAD MEDICARE
KY020394400OtherFEDERAL BLACK LUNG
OH0476373OtherOHIO MEDICAID
KY64213093Medicaid
KY4460420OtherAETNA
KY000000047402OtherANTHEM/BCBS
KY4460420OtherAETNA
KY64213093Medicaid