Provider Demographics
NPI:1427026848
Name:PHYSICIANS' HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:PHYSICIANS' HEALTH GROUP, LLC
Other - Org Name:MULTICARE SPECIALTY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-485-1818
Mailing Address - Street 1:3801 BELLEMEADE AVE
Mailing Address - Street 2:SUITE 200-A
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0100
Mailing Address - Country:US
Mailing Address - Phone:812-485-1796
Mailing Address - Fax:812-485-1790
Practice Address - Street 1:3801 BELLEMEADE AVE
Practice Address - Street 2:SUITE 200-A
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0100
Practice Address - Country:US
Practice Address - Phone:812-485-1796
Practice Address - Fax:812-485-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048785A207R00000X
IN71001430A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK6067OtherRAILROAD MEDICARE
CK6067OtherRAILROAD MEDICARE
IN194950Medicare PIN