Provider Demographics
NPI:1497873996
Name:FAMILY PHYSICIANS SOUTH LLC
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS SOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:3177-787-2644
Mailing Address - Street 1:6801 GRAY RD STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3238
Mailing Address - Country:US
Mailing Address - Phone:317-787-9471
Mailing Address - Fax:317-788-4746
Practice Address - Street 1:6801 GRAY RD STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3238
Practice Address - Country:US
Practice Address - Phone:317-787-9471
Practice Address - Fax:317-788-4746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2003960000AMedicaid
IN145180Medicare PIN
IN2003960000AMedicaid