Provider Demographics
NPI:1326181694
Name:MARCIA D. EBBS MD PSC
Entity Type:Organization
Organization Name:MARCIA D. EBBS MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:EBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-222-3927
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-0290
Mailing Address - Country:US
Mailing Address - Phone:502-222-3927
Mailing Address - Fax:
Practice Address - Street 1:1009 NEW MOODY LN
Practice Address - Street 2:SUITE 4
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9142
Practice Address - Country:US
Practice Address - Phone:502-222-3927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty