Provider Demographics
NPI:1497751945
Name:NEY, MARSHALL J (PSC)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:J
Last Name:NEY
Suffix:
Gender:M
Credentials:PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-1880
Mailing Address - Country:US
Mailing Address - Phone:859-623-3761
Mailing Address - Fax:859-623-0050
Practice Address - Street 1:527 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1880
Practice Address - Country:US
Practice Address - Phone:859-623-3761
Practice Address - Fax:859-623-0050
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60045093Medicaid
KYT54138Medicare UPIN
KY60045093Medicaid