Provider Demographics
NPI:1225200736
Name:ELLEN WEBB MD PLLC
Entity Type:Organization
Organization Name:ELLEN WEBB MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-873-0905
Mailing Address - Street 1:220 FRANKFORT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1079
Mailing Address - Country:US
Mailing Address - Phone:859-873-0905
Mailing Address - Fax:859-873-1025
Practice Address - Street 1:220 FRANKFORT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1079
Practice Address - Country:US
Practice Address - Phone:859-873-0905
Practice Address - Fax:859-873-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00630Medicare PIN