Healthcare Provider Details

I. General information

NPI: 1053508663
Provider Name (Legal Business Name): MICHAEL G. EHRIE, JR, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 SAINT CHRISTOPHER DR
ASHLAND KY
41101-7055
US

IV. Provider business mailing address

1150 SAINT CHRISTOPHER DR
ASHLAND KY
41101-7055
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-9622
  • Fax: 606-836-1986
Mailing address:
  • Phone: 606-836-9622
  • Fax: 606-836-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number21309
License Number StateKY

VIII. Authorized Official

Name: DR. MICHAEL G EHRIE JR.
Title or Position: PHYSICIAN
Credential: MD
Phone: 606-836-9622