MEDICARE: MICHAEL G. EHRIE, JR, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302F00000X	Exclusive Provider Organization	21309	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010000406	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	020394400	OTHER	KY	FEDERAL BLACK LUNG
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4460420	OTHER	KY	AETNA
6	000000047402	OTHER	KY	ANTHEM/BCBS

General Provider Information

NPI Number	:	1053508663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL G. EHRIE, JR, PSC

Provider Business Mailing Address
First Line	:	1150 SAINT CHRISTOPHER DR
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41101-7055
Country	:	US
Telephone Number	:	606-836-9622
Fax Number	:	606-836-1986

Provider Business Practice Location Address
First Line	:	1150 SAINT CHRISTOPHER DR
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41101-7055
Country	:	US
Telephone Number	:	606-836-9622
Fax Number	:	606-836-1986

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MICHAEL G EHRIE JR.
Credential	:	MD
Telephone Number	:	606-836-9622

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	08/18/2009

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