Provider Demographics
NPI:1568644771
Name:PHYSICIANS SERVICE GROUP, INC.
Entity Type:Organization
Organization Name:PHYSICIANS SERVICE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:DEHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-664-1281
Mailing Address - Street 1:PO BOX 9126
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-0126
Mailing Address - Country:US
Mailing Address - Phone:801-664-1281
Mailing Address - Fax:
Practice Address - Street 1:7369 EAST 2223 SOUTH
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109
Practice Address - Country:US
Practice Address - Phone:801-664-1281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical