Provider Demographics
NPI:1134399603
Name:GINN, MICHAEL EDWARD (RVT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:GINN
Suffix:
Gender:M
Credentials:RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 ALEXA DR STE E
Mailing Address - Street 2:P.O. BOX 664
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1000
Mailing Address - Country:US
Mailing Address - Phone:606-776-0134
Mailing Address - Fax:606-849-2166
Practice Address - Street 1:805 ALEXA DR
Practice Address - Street 2:SUITE E
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1000
Practice Address - Country:US
Practice Address - Phone:606-776-0134
Practice Address - Fax:606-849-2166
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY07195246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1600263OtherUNITED HEALTHCARE
KY000000073131OtherANTHEM PIN
KY630000472OtherRAILROAD MEDICARE
KY86010873Medicaid
KY1600263OtherUNITED HEALTHCARE
KYW80071Medicare UPIN