Provider Demographics
NPI:1174037535
Name:U.S. HEALTHWORKS MEDICAL GROUP OF INDIANA, PC
Entity Type:Organization
Organization Name:U.S. HEALTHWORKS MEDICAL GROUP OF INDIANA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-678-2600
Mailing Address - Street 1:28035 AVE STANFORD WEST
Mailing Address - Street 2:ATTN: TAMARA WEBER-ALVARADO
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355
Mailing Address - Country:US
Mailing Address - Phone:661-678-2426
Mailing Address - Fax:661-678-4684
Practice Address - Street 1:19567 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-3201
Practice Address - Country:US
Practice Address - Phone:574-277-7600
Practice Address - Fax:574-277-7690
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. HEALTHWORKS MEDICAL GROUP OF INDIANA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty