Basic Information
| Provider Information | |||||||||
| NPI: | 1023031903 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 W HIGH ST | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192277399 | ||||||||
| FaxNumber: | 4192290123 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 W HIGH ST | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192277399 | ||||||||
| FaxNumber: | 4192290123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PHILLIPS | ||||||||
| AuthorizedOfficialFirstName: | S | ||||||||
| AuthorizedOfficialMiddleName: | KATIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4192277399 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000024846 | 01 | ANTHEM | OTHER | 0236471 | 05 | OH | MEDICAID |