Provider Demographics
NPI:1184692519
Name:PHYSICIANS' HEALTH GROUP, LLC
Entity type:Organization
Organization Name:PHYSICIANS' HEALTH GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 200-E
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0100
Mailing Address - Country:US
Mailing Address - Phone:812-485-1780
Mailing Address - Fax:812-485-1775
Practice Address - Street 1:3801 BELLEMEADE AVE
Practice Address - Street 2:SUITE 200-E
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0100
Practice Address - Country:US
Practice Address - Phone:812-485-1780
Practice Address - Fax:812-485-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000408A363LF0000X
IN10150566A207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
518746OtherHEALTHLINK
7483165OtherAETNA
DE2718OtherRAILROAD MEDICARE
IN000000245639OtherBCBS
079361OtherHEALTH ALLIANCE
=========10OtherDONLEY & CO
7483165OtherAETNA
=========10OtherDONLEY & CO