MEDICARE: PATIENTFIRST MEDICAL GROUP OF MGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician

General Provider Information

NPI Number	:	1326191289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATIENTFIRST MEDICAL GROUP OF MGH

Provider Business Mailing Address
First Line	:	1251 W KEM RD
Second Line	:	SUITE E
City	:	MARION
State	:	IN
Zip	:	46952-2555
Country	:	US
Telephone Number	:	765-662-4133
Fax Number	:	765-651-7313

Provider Business Practice Location Address
First Line	:	330 N WABASH AVE
Second Line	:	SUITE 110
City	:	MARION
State	:	IN
Zip	:	46952-2677
Country	:	US
Telephone Number	:	765-662-4198
Fax Number	:	765-662-4012

Authorized Official
Title or Position	:	ASST VP
Name	:	JAMES B DAVIS
Credential	:
Telephone Number	:	765-651-7388

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	06/25/2008

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