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General NPI Number Information
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NPI Number | 1184912370
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Entity Type | Organization
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Legal Business Name | FMMG LLC
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 1850 STATE ST
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City | NEW ALBANY
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State | IN
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Zip | 47150-4990
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Country | US
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Telephone | 812-542-4906
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Fax | 812-949-5966
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Provider Business Mailing Address
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Address Line | 800 HIGHLANDER POINT DR STE 204
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City | FLOYDS KNOBS
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State | IN
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Zip | 47119-9465
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Country | US
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Telephone | 812-542-4906
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Fax | 812-948-6715
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | DANIEL J EICHENBERGER
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Credential | MD
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Telephone | 812-542-4921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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Taxonomy #3
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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Taxonomy #4
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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Taxonomy #6
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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Taxonomy #7
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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Taxonomy #8
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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