Provider Demographics
NPI:1588717813
Name:PHYSICIANS' BILLING OF MGH
Entity type:Organization
Organization Name:PHYSICIANS' BILLING OF MGH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:USHER
Authorized Official - Last Name:L
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE, CPA, FHFMA
Authorized Official - Phone:765-662-4776
Mailing Address - Street 1:1251 W KEM RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2555
Mailing Address - Country:US
Mailing Address - Phone:765-662-4133
Mailing Address - Fax:765-165-1731
Practice Address - Street 1:2651 S 800 W
Practice Address - Street 2:
Practice Address - City:SWAYZEE
Practice Address - State:IN
Practice Address - Zip Code:46986-9615
Practice Address - Country:US
Practice Address - Phone:765-922-7056
Practice Address - Fax:765-922-7059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARION GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100269250Medicaid
IN100269250Medicaid