Basic Information
| Provider Information | |||||||||
| NPI: | 1932402971 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLOYD MEMORIAL MEDICAL GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 727 MOUNT TABOR RD STE A | ||||||||
| Address2: | |||||||||
| City: | NEW ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471506951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129452717 | ||||||||
| FaxNumber: | 8129486572 | ||||||||
| Practice Location | |||||||||
| Address1: | 727 MOUNT TABOR RD STE A | ||||||||
| Address2: | |||||||||
| City: | NEW ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471506951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129452717 | ||||||||
| FaxNumber: | 8129486572 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2010 | ||||||||
| LastUpdateDate: | 12/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | TROUTMAN | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 8129487632 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FLOYD MEMORIAL HOSPITAL & HEALTH SERVICES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.