MEDICARE: PREFERRED INJURY PHYSICIANS 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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1952955056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED INJURY PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	7145 E VIRGINIA ST STE 2000
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-9147
Country	:	US
Telephone Number	:	812-962-7890
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 OLD ROSEBUD RD STE 330
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-8630
Country	:	US
Telephone Number	:	812-962-7890
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CLIENT SERVICES
Name	:	BONNIE GAIL WAELDE
Credential	:
Telephone Number	:	812-459-4959

Provider Enumeration Date	:	07/26/2019
Last Update Date	:	07/26/2019

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