Provider Demographics
NPI:1881630739
Name:MED 1ST OF EVANSVILLE, PC
Entity Type:Organization
Organization Name:MED 1ST OF EVANSVILLE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:POELING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-473-4011
Mailing Address - Street 1:PO BOX 4506
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47724-0506
Mailing Address - Country:US
Mailing Address - Phone:812-473-4011
Mailing Address - Fax:812-474-4581
Practice Address - Street 1:1401 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-2056
Practice Address - Country:US
Practice Address - Phone:812-473-4011
Practice Address - Fax:812-474-4581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN156619OtherMEDICARE OUTPATIENT REHAB FACILITY
IN5358340001OtherDMERC PTAN
IN5358340001OtherDMERC PTAN