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General NPI Number Information
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NPI Number | 1326181694
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Entity Type | Organization
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Legal Business Name | MARCIA D. EBBS MD PSC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1009 NEW MOODY LN SUITE 4
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City | LAGRANGE
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State | KY
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Zip | 40031-9142
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Country | US
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Telephone | 502-222-3927
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 290
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City | LAGRANGE
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State | KY
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Zip | 40031-0290
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Country | US
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Telephone | 502-222-3927
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | PETER EBBS
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Credential |
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Telephone | 502-222-3927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 30727
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License Number State | KY
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