Provider Demographics
NPI:1710118237
Name:PHYSICIANS' BILLING OF MGH
Entity Type:Organization
Organization Name:PHYSICIANS' BILLING OF MGH
Other - Org Name:DOUGLAS REX, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
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 KEM ROAD
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:765-651-7313
Practice Address - Street 1:330 N WABASH
Practice Address - Street 2:SUITE 340
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2678
Practice Address - Country:US
Practice Address - Phone:765-664-3916
Practice Address - Fax:765-662-4724
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARION GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-31
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100269250Medicaid
IN296260Medicare PIN