Provider Demographics
NPI:1205175890
Name:PHYSICIAN SERVICES GROUP
Entity type:Organization
Organization Name:PHYSICIAN SERVICES GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-332-5155
Mailing Address - Street 1:9736 DAYTON PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-4727
Mailing Address - Country:US
Mailing Address - Phone:423-332-5155
Mailing Address - Fax:423-332-5195
Practice Address - Street 1:6009 BROWNSBORO PARK BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1291
Practice Address - Country:US
Practice Address - Phone:502-253-6881
Practice Address - Fax:502-253-6882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-03
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier