PROVIDENCE MEDICAL GROUP LLC NPI 1891729141

NPI Information

NPI: 1891729141
Provider Name: PROVIDENCE MEDICAL GROUP LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 15D0693264

Address:
2723 S 7TH ST
SUITE A
TERRE HAUTE, IN
ZIP 47802
Phone: (812) 232-8164
Get Directions

PROVIDENCE MEDICAL GROUP LLC is a multi-specialty clinic center in Terre Haute, IN. PROVIDENCE MEDICAL GROUP LLC NPI is 1891729141. The provider is registered as an organization entity type.

The provider's business location address is:

2723 S 7TH ST
SUITE A
TERRE HAUTE, IN
ZIP 47802-558
Phone: (812) 232-8164
Fax: (812) 234-6391

The provider's authorized official is George B Bittar .
The authorized official title is Owner and has the following contact phone number (812) 232-8164.

The CLIA number assigned to this NPI record is 15D0693264 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/11/2006 and was last updated on 10/9/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty		INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	200261130	MEDICAID	INDIANA
2	200398780	MEDICAID	INDIANA
3	CG4466	OTHER	INDIANA	RAILROAD MEDICARE
4	CH9272	OTHER	INDIANA	RAILROAD MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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