Provider Demographics
NPI:1205919594
Name:GEORGE W GRIFFITH MD PSC
Entity type:Organization
Organization Name:GEORGE W GRIFFITH MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-256-2961
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456
Mailing Address - Country:US
Mailing Address - Phone:606-256-2961
Mailing Address - Fax:606-256-3562
Practice Address - Street 1:160 E, MAIN ST
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-0609
Practice Address - Country:US
Practice Address - Phone:606-256-2961
Practice Address - Fax:606-256-3562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000064717OtherANTHEM BCBS
KY64173776Medicaid
KY080139245OtherRAILROAD MC
KY64173776Medicaid
KY1790101Medicare ID - Type Unspecified