Provider Demographics
NPI:1700083979
Name:MICHELLE MURRAY, DPM, PSC
Entity Type:Organization
Organization Name:MICHELLE MURRAY, DPM, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:606-833-0338
Mailing Address - Street 1:1101 SAINT CHRISTOPHER DRIVE
Mailing Address - Street 2:SUITE 355
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7000
Mailing Address - Country:US
Mailing Address - Phone:606-833-0338
Mailing Address - Fax:606-833-0339
Practice Address - Street 1:1101 SAINT CHRISTOPHER DRIVE
Practice Address - Street 2:SUITE 355
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7000
Practice Address - Country:US
Practice Address - Phone:606-833-0338
Practice Address - Fax:606-833-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
KY00311213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6211910001Medicare NSC