Basic Information
| Provider Information | |||||||||
| NPI: | 1255794541 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHOEBE PHYSICIAN GROUP, INC | ||||||||
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| OtherOrganizationName: | PHOEBE ELECTROPHYSIOLOGY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W 3RD AVE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317011985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293125800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 425 W 3RD AVE STE 700 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317011969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293127790 | ||||||||
| FaxNumber: | 2293127795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2016 | ||||||||
| LastUpdateDate: | 04/04/2016 | ||||||||
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| AuthorizedOfficialLastName: | HEAD | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2293126721 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PHOEBE PHYSICIAN GROUP, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 059422 | GA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 059422 | GA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No ID Information.