Provider Demographics
NPI:1649359514
Name:EBBS, MARCIA D (MD PSC)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:D
Last Name:EBBS
Suffix:
Gender:F
Credentials:MD PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 NEW MOODY LN
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9122
Mailing Address - Country:US
Mailing Address - Phone:502-593-0083
Mailing Address - Fax:502-222-0029
Practice Address - Street 1:1006 NEW MOODY LN
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9122
Practice Address - Country:US
Practice Address - Phone:502-593-0083
Practice Address - Fax:502-222-0029
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0100865OtherUHC
KY64307275Medicaid
KY000052153DOtherHUMANA - NCMA
KY118157OtherSIHO - NICC
KY50027441OtherPASSPORT - NCMA
KY019456OtherSIHO - NCMA
KY6935264OtherCIGNA - NCMA
KY000000644690OtherANTHEM - NCMA
KY000000675746OtherANTHEM - NICC
0697701Medicare ID - Type Unspecified
KY64307275Medicaid
0100865OtherUHC
KY118157OtherSIHO - NICC
KY00546181Medicare Oscar/Certification