Provider Demographics
NPI:1639409659
Name:BRENTWOOD MEADOWS PHYSICIAN GROUP
Entity Type:Organization
Organization Name:BRENTWOOD MEADOWS PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-786-6621
Mailing Address - Street 1:4488 ROSLIN RD.
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8539
Mailing Address - Country:US
Mailing Address - Phone:812-858-7200
Mailing Address - Fax:812-842-0086
Practice Address - Street 1:4488 ROSLIN RD.
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8539
Practice Address - Country:US
Practice Address - Phone:812-858-7200
Practice Address - Fax:812-842-0086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRENTWOOD MEADOWS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty