Provider Demographics
NPI:1790925782
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 PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHISTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-949-5500
Mailing Address - Street 1:1850 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4990
Mailing Address - Country:US
Mailing Address - Phone:812-981-6673
Mailing Address - Fax:812-949-5476
Practice Address - Street 1:2315 GREEN VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4649
Practice Address - Country:US
Practice Address - Phone:812-945-2100
Practice Address - Fax:812-945-9495
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLOYD MEMORIAL HOSPITAL & HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-03
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200915700Medicaid
IN260810Medicare PIN