Provider Demographics
NPI:1891773495
Name:PHYSICIANS HEALTH GROUP LLC
Entity Type:Organization
Organization Name:PHYSICIANS HEALTH GROUP LLC
Other - Org Name:PHG DIAGNOSTIC TESTING CENTER - LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-485-1818
Mailing Address - Street 1:3801 BELLEMEADE AVE
Mailing Address - Street 2:SUITE 010
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0100
Mailing Address - Country:US
Mailing Address - Phone:812-485-1808
Mailing Address - Fax:812-485-1809
Practice Address - Street 1:3801 BELLEMEADE AVE
Practice Address - Street 2:SUITE 010
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0100
Practice Address - Country:US
Practice Address - Phone:812-485-1808
Practice Address - Fax:812-485-1809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00018148OtherRAILROAD MEDICARE
P00018148OtherRAILROAD MEDICARE
P00018148OtherRAILROAD MEDICARE