Providence Medical Group, Llc

NPI 1013087048 - Clinic/Center - 261QR1300X

NPI Details
NPI 1013087048
Enumeration Date 11/08/2006
Last Updated 11/01/2012
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name GEORGE B GEORGE
Position OWNER
Phone (812) 442-2100
Fax
Practice Location
115 S MURPHY AVE
STE A
BRAZIL IN, 47834-8296, US
Phone (812) 442-2100
Fax
Business Location
2723 S 7TH ST STE A
TERRE HAUTE IN, 47802-3558, US
Phone (812) 238-1730
Fax (812) 242-1565
Toxanomy
Taxonomy Code 261QR1300X
License State
License Number
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According to our database, Providence Medical Group, Llc NPI is 1013087048, taxonomy code is 261QR1300X Providence Medical Group, Llc physically located at 115 S Murphy Ave, Brazil IN, 47834-8296. NPI Number 1033115704 has the healthcare provider type.

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1013087048 NPI number is provided on an as is basis without warranty of any kind. 1013087048 is maintained by the National Plan & Provider Enumeration System. The contents of Providence Medical Group, Llc are for informational purposes only.