Provider Demographics
NPI:1790779379
Name:PHYSICIANS GROUP INC
Entity Type:Organization
Organization Name:PHYSICIANS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-948-9271
Mailing Address - Street 1:1919 STATE ST
Mailing Address - Street 2:SUITE 440
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4929
Mailing Address - Country:US
Mailing Address - Phone:812-948-9271
Mailing Address - Fax:812-941-4506
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:SUITE 440
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4929
Practice Address - Country:US
Practice Address - Phone:812-948-9271
Practice Address - Fax:812-941-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052963A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN241470Medicare ID - Type Unspecified