Provider Demographics
NPI:1326191289
Name:PATIENTFIRST MEDICAL GROUP OF MGH
Entity Type:Organization
Organization Name:PATIENTFIRST MEDICAL GROUP OF MGH
Other - Org Name:PATIENTFIRST WORK RITE OF MGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST VP
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-651-7388
Mailing Address - Street 1:1251 W KEM RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2555
Mailing Address - Country:US
Mailing Address - Phone:765-662-4133
Mailing Address - Fax:765-651-7313
Practice Address - Street 1:330 N WABASH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2677
Practice Address - Country:US
Practice Address - Phone:765-662-4198
Practice Address - Fax:765-662-4012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARION GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-22
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty