Organization
FAMILY PRACTICE OF GREENVILLE PSC
Active
Other names
Marshall E Prunty MD
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHALL EDWARD PRUNTY MD (CEO PHYSICIAN OWNER)
(270) 338-0600
Entity
Organization
Contact information
Practice address
601 GREENE DR, GREENVILLE, KY 42345-1451
(270) 338-0600
(270) 338-0605
Mailing address
601 GREENE DR, FAMILY PRACTICE OF GREENVILLE PSC, GREENVILLE, KY 42345-1451
(270) 338-0600
(270) 338-0605
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22988
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000048338
ANTHEM BCBS
KY
01
—
080193902
RAILROAD MEDICARE
—
05
—
64229883
—
KY
Enumeration date
03/27/2007
Last updated
01/04/2011
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