Provider Demographics
NPI:1952379307
Name:PHYSICIANS' HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:PHYSICIANS' HEALTH GROUP, LLC
Other - Org Name:RICHARD GRIES M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
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:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:HAUBSTADT
Mailing Address - State:IN
Mailing Address - Zip Code:47639-0370
Mailing Address - Country:US
Mailing Address - Phone:812-464-3016
Mailing Address - Fax:812-753-4148
Practice Address - Street 1:304 E. HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:HAUBSTADT
Practice Address - State:IN
Practice Address - Zip Code:47639
Practice Address - Country:US
Practice Address - Phone:812-464-3016
Practice Address - Fax:812-753-4148
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
IN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
065639OtherHEALTH ALLIANCE
IN000000245598OtherBCBS
CK5998OtherRAILROAD MEDICARE
=========17OtherDONLEY & CO
065639OtherHEALTH ALLIANCE
065639OtherHEALTH ALLIANCE