Provider Demographics
NPI:1518146703
Name:PHYSICIANS' BILLING OF MGH
Entity Type:Organization
Organization Name:PHYSICIANS' BILLING OF MGH
Other - Org Name:MGH SPECIALTY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:USHER
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE, CPA, FHFMA
Authorized Official - Phone:765-662-4776
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:765-251-7313
Practice Address - Street 1:330 N WABASH AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2686
Practice Address - Country:US
Practice Address - Phone:765-671-3153
Practice Address - Fax:765-671-3155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARION GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-24
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100269250Medicaid
IN296260Medicare PIN