Basic Information
| Provider Information | |||||||||
| NPI: | 1639409659 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRENTWOOD MEADOWS PHYSICIAN GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4488 ROSLIN RD. | ||||||||
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| City: | NEWBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476308539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128587200 | ||||||||
| FaxNumber: | 8128420086 | ||||||||
| Practice Location | |||||||||
| Address1: | 4488 ROSLIN RD. | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476308539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128587200 | ||||||||
| FaxNumber: | 8128420086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2010 | ||||||||
| LastUpdateDate: | 01/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | HAMMER | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8127866621 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BRENTWOOD MEADOWS LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0802X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry |
No ID Information.