Provider Demographics
NPI:1326059171
Name:DOCTORS HEALTH GROUP INC
Entity Type:Organization
Organization Name:DOCTORS HEALTH GROUP INC
Other - Org Name:PIGGOTT FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DOCTORS HEALTH GROUP INC
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:LIEBLONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-7024
Mailing Address - Street 1:425 WEST JACKSON
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-1538
Mailing Address - Country:US
Mailing Address - Phone:870-598-2236
Mailing Address - Fax:870-598-3080
Practice Address - Street 1:425 WEST JACKSON
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-1538
Practice Address - Country:US
Practice Address - Phone:870-598-2236
Practice Address - Fax:870-598-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR043834Medicare PIN
ARMC2135Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER