MEDICARE: PHOEBE PHYSICIAN GROUP INC

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	261QR1300X	Rural Health Clinic/Center
2	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487899464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOEBE PHYSICIAN GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 13493
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4025
Country	:	US
Telephone Number	:	229-312-5800
Fax Number	:	229-312-5853

Provider Business Practice Location Address
First Line	:	500 W 3RD AVE STE 101
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701-1900
Country	:	US
Telephone Number	:	229-312-5800
Fax Number	:	229-312-5853

Authorized Official
Title or Position	:	SR VP OF PHYSICIAN PRACTICES
Name	:	ROBERT LAGESSE
Credential	:
Telephone Number	:	229-312-1000

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	06/26/2014

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Directions to “PHOEBE PHYSICIAN GROUP INC ” Practice Location

Language	Start Address	Practice Location

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