Basic Information
| Provider Information | |||||||||
| NPI: | 1144518002 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LUTHERAN MEDICAL GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4852 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778481463 | ||||||||
| FaxNumber: | 6159254991 | ||||||||
| Practice Location | |||||||||
| Address1: | 504 W SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | MONROEVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467739592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2606236196 | ||||||||
| FaxNumber: | 2604785125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2011 | ||||||||
| LastUpdateDate: | 07/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | BREWER | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8778929813 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.