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NPI Code Detail

MEDICARE: PHYSICIAN MANAGEMENT SERVICES OF WESTERN INDIANA, LLC

MEDICARE: PHYSICIAN MANAGEMENT SERVICES OF WESTERN INDIANA, LLC
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
1207Q00000XFamily Medicine Physician01050928AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PHC059OTHERMEDICARE PTAN

General Provider Information

NPI Number : 1497107775
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIAN MANAGEMENT SERVICES OF WESTERN INDIANA, LLC
Provider Business Mailing Address
First Line : 800 N MAGNOLIA AVE STE 700
Second Line :
City : ORLANDO
State : FL
Zip : 32803-3264
Country : US
Telephone Number : 888-829-8550
Fax Number :
Provider Business Practice Location Address
First Line : 4933 E PLAZA EAST BLVD
Second Line :
City : EVANSVILLE
State : IN
Zip : 47715-2813
Country : US
Telephone Number : 888-829-8550
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : CASEY DELOACH
Credential :
Telephone Number : 888-829-8550
Provider Enumeration Date : 07/11/2016
Last Update Date : 05/21/2026

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Directions to “PHYSICIAN MANAGEMENT SERVICES OF WESTERN INDIANA, LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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