Provider Demographics
NPI:1528479029
Name:BRENTWOOD MEADOWS PHYSICIAN GROUP LLC
Entity type:Organization
Organization Name:BRENTWOOD MEADOWS PHYSICIAN GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:812-858-7200
Mailing Address - Street 1:4488 ROSLIN RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8590
Mailing Address - Country:US
Mailing Address - Phone:812-858-7200
Mailing Address - Fax:812-842-0086
Practice Address - Street 1:4488 ROSLIN RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8590
Practice Address - Country:US
Practice Address - Phone:812-858-7200
Practice Address - Fax:812-842-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty