Provider Demographics
NPI:1124580899
Name:PMGG, LLC
Entity Type:Organization
Organization Name:PMGG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-975-1973
Mailing Address - Street 1:11320 STILL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1299
Mailing Address - Country:US
Mailing Address - Phone:317-975-1973
Mailing Address - Fax:317-975-1973
Practice Address - Street 1:11320 STILL CREEK DR
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1299
Practice Address - Country:US
Practice Address - Phone:317-975-1973
Practice Address - Fax:317-975-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health