Provider Demographics
NPI:1700849692
Name:DOCTORS HEALTH GROUP, INC
Entity Type:Organization
Organization Name:DOCTORS HEALTH GROUP, INC
Other - Org Name:PARAGOULD DOCTORS' CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBLONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-7024
Mailing Address - Street 1:4000 LINWOOD DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-7224
Mailing Address - Country:US
Mailing Address - Phone:870-239-8503
Mailing Address - Fax:870-236-1947
Practice Address - Street 1:4000 LINWOOD DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-7224
Practice Address - Country:US
Practice Address - Phone:870-239-8503
Practice Address - Fax:870-236-1947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130301002Medicaid
AR57100Medicare PIN