Provider Demographics
NPI:1295074888
Name:PHYSICIAN SERVICES GROUP, INC
Entity type:Organization
Organization Name:PHYSICIAN SERVICES GROUP, INC
Other - Org Name:
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 1:8118 CORPORATE WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7350
Practice Address - Country:US
Practice Address - Phone:513-229-0872
Practice Address - Fax:513-229-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-03
Last Update Date:2013-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies