Provider Demographics
NPI:1154879237
Name:PHYSICIANS MEDICAL AND INJURY GROUP, LLC
Entity type:Organization
Organization Name:PHYSICIANS MEDICAL AND INJURY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:VON BARGEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:386-279-0943
Mailing Address - Street 1:1450 S WOODLAND BLVD STE 200A
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-7547
Mailing Address - Country:US
Mailing Address - Phone:386-279-0943
Mailing Address - Fax:386-873-4217
Practice Address - Street 1:1450 S WOODLAND BLVD STE 200A
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-7547
Practice Address - Country:US
Practice Address - Phone:386-279-0943
Practice Address - Fax:386-873-4217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty