PROVIDENCE MEDICAL GROUP LLC (NPI# 1891729141) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891729141 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE MEDICAL GROUP LLC |
| Practice Address |
2723 S 7th St Suite A Terre Haute IN 47802-3558 |
| Practice Telephone | 8122328164 |
| Practice Fax Number | 8122346391 |
| Mailing Telephone | 8122381730 |
| Mailing Fax Number | 8182421565 |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-10-09 |
| Authorized Official Name | GEORGE B BITTAR (OWNER) |
| Authorized Official Telephone | 8122328164 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
IN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200261130 | 05 | |
| IN | 200398780 | 05 | |
| IN | RAILROAD MEDICARE | CG4466 | 01 |
| IN | RAILROAD MEDICARE | CH9272 | 01 |
| Street Address |
2723 S 7TH ST SUITE A |
| City | TERRE HAUTE |
| State | IN |
| Zip Code | 47802-3558 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538150974 | Karen D Smith | Nurse Practitioner | 2723 S 7th St, Suite A, Terre Haute, IN 47802-3558 | 2005-11-03 |
| 1710213665 | Lynne Anne Adams | Nurse Practitioner | 2723 S 7th St, St O, Terre Haute, IN 47802 | 2009-10-28 |
| 1104076306 | Procare Medical LLC | Hospitalist | 2723 S 7th St, Ste A, Terre Haute, IN 47802-3558 | 2008-09-24 |
| 1083898993 | Agam Enterprises | Radiology | 2723 S 7th St, Terre Haute, IN 47802-3584 | 2007-12-27 |
| 1437352903 | Rao Ivaturi | Nutritionist | 2723 S 7th St, Suite A, Terre Haute, IN 47802-3558 | 2007-06-11 |
| 1497808893 | Joel N Elias | Internal Medicine | 2723 S 7th St, Suite L, Terre Haute, IN 47802-3558 | 2007-01-19 |
| 1982778080 | Providence Cath Lab | Clinical Medical Laboratory | 2723 S 7th St, Suite A, Terre Haute, IN 47802-3584 | 2006-11-20 |
| 1437183456 | Med-a-care LLC | Durable Medical Equipment & Medical Supplies | 2723 S 7th St, Suite N, Terre Haute, IN 47802-3584 | 2006-07-10 |
| 1417980483 | John Yacoub | Internal Medicine | 2723 S 7th St, Suite A, Terre Haute, IN 47802-3558 | 2006-07-09 |
| 1386618536 | Thomas F Orman | Internal Medicine | 2723 S 7th St, Suite A, Terre Haute, IN 47802-3558 | 2006-02-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184242364 | Sowjanya Gunukula | Dentist | 3359 S Us Hwy 41, Terre Haute, IN 47802 | 2020-07-14 |
| 1366005027 | Irma D Davis Lmft | Marriage & Family Therapist | 1400 South Pugh Drive, Suite #3, Terre Haute, IN 47802 | 2019-04-18 |
| 1255892543 | Darcie Jo Antony | Dietitian, Registered | 3901 South 7th St, Dietitian's Office 4th Floor, Terre Haute, IN 47802 | 2019-03-28 |
| 1548726003 | James Brian Levenson | Nurse Practitioner | 670 Margaret Dr, Terre Haute, IN 47802 | 2019-02-20 |
| 1972011815 | Wellness for Life Medical LLC | Clinic/Center | 3487 S 4th St, Terre Haute, IN 47802 | 2018-01-12 |
| 1992211965 | Megan Elizabeth Marietta | Nurse Practitioner | 3487 S 4th Street, Terre Haute, IN 47802 | 2017-12-28 |
| 1396187944 | Marc Keilman | Pharmacist | 1240 E Hook Dr, Terre Haute, IN 47802 | 2013-07-24 |
| 1043563364 | Indiana Hearing LLC | Hearing Aid Equipment | 3181 S 3rd Pl, Terre Haute, IN 47802 | 2012-10-24 |
| 1619241783 | Michael James Elkins Shanks | Urology | 3401 S 4th St, Terre Haute, IN 47802 | 2012-03-06 |
| 1073890208 | Christopher Allan Blila | Nurse Practitioner | 4700 Bureau Road South, Terre Haute, IN 47802 | 2011-11-16 |
| Find all providers in zip 47802 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942491709 | Hospital & Medical Foundation of Paris, Inc | Clinic/Center | 1530 N 7th St, Terre Haute, IN 47807-1057 | 2007-08-07 |
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|---|---|---|---|---|
| 1184231037 | Crossover Health Medical Group | Clinic/Center | 434 Patrol Rd, Jeffersonville, IN 47130-7754 | 2020-09-24 |
| 1659984870 | Central Indiana Vascular Care, LLC. | Clinic/Center | 853 N Emerson Ave Ste F, Greenwood, IN 46143-5676 | 2020-08-27 |
| 1518528579 | Johnson Nichols Health Clinic, Inc. | Clinic/Center | 390 Erie Ave Ste A, Connersville, IN 47331-3177 | 2019-06-21 |
| 1932677291 | Pure Life Clinic LLC | Clinic/Center | 4725 Statesmen Dr Ste B, Indianapolis, IN 46250-5645 | 2018-11-05 |
| 1417479247 | Crown Radiology Associates | Clinic/Center | 5363 Commerce Blvd Ste A, Crown Point, IN 46307-5325 | 2017-07-13 |
| 1346634946 | Healthworks Med Group of Indiana P C | Clinic/Center | 6620 Network Way, Indianapolis, IN 46278-1686 | 2015-03-23 |
| 1477970440 | American Health Network of Indiana, LLC | Clinic/Center | 2625 N Morton St, Kyb Health and Wellness Clinic, Franklin, IN 46131-8820 | 2014-03-27 |
| 1952626715 | K & D Medical Services | Clinic/Center | 425 Joliet St Ste 125, Dyer, IN 46311-1775 | 2010-04-05 |
| 1407179559 | Forensic Nursing Specialties, Inc | Clinic/Center | 2270 Lake Ave, Suite 201, Fort Wayne, IN 46805-5359 | 2010-03-03 |
| 1235372277 | Lagrange Surgery Center, LLC | Clinic/Center | 2500 Ventura Way, Lagrange, IN 46761 | 2009-04-07 |
| Find all providers with the same taxonomy | ||||
| City | TERRE HAUTE |
| Zip Code | 47802 |
Please comment or provide details below to improve the information on PROVIDENCE MEDICAL GROUP LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.