Provider Demographics
NPI:1700189743
Name:FLOYD MEMORIAL MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:FLOYD MEMORIAL MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TROUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-948-7632
Mailing Address - Street 1:3605 NORTHGATE CT STE 207
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6422
Mailing Address - Country:US
Mailing Address - Phone:812-941-9355
Mailing Address - Fax:812-941-9312
Practice Address - Street 1:3605 NORTHGATE CT STE 207
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6422
Practice Address - Country:US
Practice Address - Phone:812-941-9355
Practice Address - Fax:812-941-9312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLOYD MEMORIAL HOSPITAL & HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty