Provider Demographics
NPI:1124367586
Name:PHYSICIAN SERVICES GROUP
Entity Type:Organization
Organization Name:PHYSICIAN SERVICES GROUP
Other - Org Name:PHYSICIAN SERVICES GROUP, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-332-5155
Mailing Address - Street 1:9736 DAYTON PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SODDY-DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379
Mailing Address - Country:US
Mailing Address - Phone:423-332-5155
Mailing Address - Fax:423-332-5195
Practice Address - Street 1:9736 DAYTON PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-4727
Practice Address - Country:US
Practice Address - Phone:423-332-5155
Practice Address - Fax:423-332-5195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6730440001Medicare NSC