1770761975 NPI number — PHYSICIANS' BILLING OF MGH

Table of content: (NPI 1770761975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770761975 NPI number — PHYSICIANS' BILLING OF MGH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS' BILLING OF MGH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770761975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
717 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAS CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46933-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-677-4719
Provider Business Practice Location Address Fax Number:
765-677-4727
Provider Enumeration Date:
02/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
USHER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
765-662-4776

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01036109A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100269250 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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