Provider Demographics
NPI:1154872810
Name:U.S. HEALTHWORKS MEDICAL GROUP OF INDIANA, PC
Entity type:Organization
Organization Name:U.S. HEALTHWORKS MEDICAL GROUP OF INDIANA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:MALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-678-2600
Mailing Address - Street 1:25124 SPRINGFIELD CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1085
Mailing Address - Country:US
Mailing Address - Phone:661-678-2600
Mailing Address - Fax:661-678-2700
Practice Address - Street 1:5603 W RAYMOND ST
Practice Address - Street 2:SUITE A-D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-4364
Practice Address - Country:US
Practice Address - Phone:317-241-8266
Practice Address - Fax:317-247-4978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S HEALTHWORKS MEDICAL GROUP OF INDIANA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine