Provider Demographics
NPI:1255382040
Name:PREFERRED PHYSICIANS PC
Entity type:Organization
Organization Name:PREFERRED PHYSICIANS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MYRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-726-9027
Mailing Address - Street 1:822 S 500 W
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-8377
Mailing Address - Country:US
Mailing Address - Phone:260-726-9027
Mailing Address - Fax:260-726-9529
Practice Address - Street 1:822 S 500 W
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-8377
Practice Address - Country:US
Practice Address - Phone:260-726-9027
Practice Address - Fax:260-726-9529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN142560Medicare ID - Type UnspecifiedMEDICARE