Provider Demographics
NPI:1972054146
Name:DOCTORS HEALTH GROUP, INC.
Entity Type:Organization
Organization Name:DOCTORS HEALTH GROUP, INC.
Other - Org Name:ST. BERNARDS FIRST CARE- TRUMANN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHYSICIAN SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBLONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-7024
Mailing Address - Street 1:800 S MAIN ST
Mailing Address - Street 2:P.O. BOX 1331
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3548
Mailing Address - Country:US
Mailing Address - Phone:870-932-7024
Mailing Address - Fax:870-930-9377
Practice Address - Street 1:1300 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-9702
Practice Address - Country:US
Practice Address - Phone:870-972-8181
Practice Address - Fax:870-930-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty