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General NPI Number Information
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NPI Number | 1366122566
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Entity Type | Organization
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Legal Business Name | PDS GROUP LLC
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Dates
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Enumeration Date | 07/21/2023
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 2559 S ADDISYN LN
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City | BLOOMINGTON
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State | IN
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Zip | 47403-3269
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Country | US
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Telephone | 317-349-7680
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Fax | 833-975-0724
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Provider Business Mailing Address
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Address Line | 2559 S ADDISYN LN
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City | BLOOMINGTON
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State | IN
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Zip | 47403-3269
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Country | US
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Telephone | 317-349-7680
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Fax | 833-975-0724
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. JAMES PENTICUFF
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Credential |
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Telephone | 317-714-2754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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