Healthcare Provider Details

I. General information

NPI: 1427026848
Provider Name (Legal Business Name): PHYSICIANS' HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BELLEMEADE AVE SUITE 200-A
EVANSVILLE IN
47714-0100
US

IV. Provider business mailing address

3801 BELLEMEADE AVE SUITE 200-A
EVANSVILLE IN
47714-0100
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-1796
  • Fax: 812-485-1790
Mailing address:
  • Phone: 812-485-1796
  • Fax: 812-485-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001430A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01048785A
License Number StateIN

VIII. Authorized Official

Name: MRS. CAROLYN WEINERT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 812-485-1818