| Providence Medical Group Llc | |
|
2723 S 7th St Suite A Terre Haute IN 47802-3558 | |
| (812) 232-8164 | |
| (812) 234-6391 |
| Full Name | Providence Medical Group Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2723 S 7th St, Terre Haute, Indiana |
| Authorized Official Name and Position | George B Bittar (OWNER) |
| Authorized Official Contact | 8122328164 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Llc 2723 S 7th St Suite A Terre Haute IN 47802-3558 Ph: (812) 238-1730 | Providence Medical Group Llc 2723 S 7th St Suite A Terre Haute IN 47802-3558 Ph: (812) 232-8164 |
| NPI Number | 1891729141 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 10/09/2020 |
| Medicare PECOS PAC ID | 9335135995 |
|---|---|
| Medicare Enrollment ID | O20040421000546 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891729141 | NPI | - | NPPES |
| CG4466 | Other | IN | RAILROAD MEDICARE |
| CH9272 | Other | IN | RAILROAD MEDICARE |
| 200261130 | Medicaid | IN | |
| 200398780 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (Indiana) | Primary |
| Provider Name | Sang Huh |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1194799742 PECOS PAC ID: 1951394006 Enrollment ID: I20040406000148 |
| Provider Name | Tony K Nasser |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1104803295 PECOS PAC ID: 0042295180 Enrollment ID: I20040622001138 |
| Provider Name | Nawar F Mercho |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1124092325 PECOS PAC ID: 9739135070 Enrollment ID: I20050329001325 |
| Provider Name | Elias A Dalloul |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1316910912 PECOS PAC ID: 3173579414 Enrollment ID: I20050329001336 |
| Provider Name | Neil G Kabous |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1174597744 PECOS PAC ID: 6709832041 Enrollment ID: I20050329001349 |
| Provider Name | George B Bittar |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1801869615 PECOS PAC ID: 5092760694 Enrollment ID: I20050329001353 |
| Provider Name | Mohammad Saiful Alam |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1972577591 PECOS PAC ID: 6901847037 Enrollment ID: I20050518000962 |
| Provider Name | Imad George Koj |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073503207 PECOS PAC ID: 0042237984 Enrollment ID: I20051029000112 |
| Provider Name | John Yacoub |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1417980483 PECOS PAC ID: 7911994116 Enrollment ID: I20061212000074 |
| Provider Name | Rajalakshmi V Shantharam |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1982786562 PECOS PAC ID: 4688770928 Enrollment ID: I20070503000395 |
| Provider Name | Antwan Mardini |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982678470 PECOS PAC ID: 7911095054 Enrollment ID: I20071126000686 |
| Provider Name | Paula J Market |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730178906 PECOS PAC ID: 8325118268 Enrollment ID: I20080603000774 |
| Provider Name | Joni K Steele |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093938177 PECOS PAC ID: 6507924487 Enrollment ID: I20081021000782 |
| Provider Name | Harold P Loveall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962476440 PECOS PAC ID: 1052354453 Enrollment ID: I20100112000229 |
| Provider Name | Henry Johannes Davis |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1174597538 PECOS PAC ID: 0749324101 Enrollment ID: I20100223000454 |
| Provider Name | Thomas F Orman |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1386618536 PECOS PAC ID: 2466597851 Enrollment ID: I20100310000469 |
| Provider Name | David Janicki |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336113638 PECOS PAC ID: 7113053158 Enrollment ID: I20100330000471 |
| Provider Name | Jamiley C Maynard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689897886 PECOS PAC ID: 0345377610 Enrollment ID: I20100416000731 |
| Provider Name | Robert Curtis Oehler |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891769667 PECOS PAC ID: 4183816788 Enrollment ID: I20101013001170 |
| Provider Name | Joseph Y Abdayem |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134375157 PECOS PAC ID: 0749462588 Enrollment ID: I20110315000612 |
| Provider Name | Melhem Jabbour |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1851697536 PECOS PAC ID: 7911175781 Enrollment ID: I20140725001761 |
| Provider Name | Kimberley A Zinkovich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568865731 PECOS PAC ID: 8921228065 Enrollment ID: I20141013001045 |
| Provider Name | Staci Rice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942711643 PECOS PAC ID: 6204102916 Enrollment ID: I20171025001162 |
| Provider Name | Stephanie Stidman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942843644 PECOS PAC ID: 1254768823 Enrollment ID: I20200219002622 |
| Provider Name | Jennifer J Pence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871263731 PECOS PAC ID: 2668861097 Enrollment ID: I20211105000440 |
| Provider Name | Ashley Nicole Richey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609539923 PECOS PAC ID: 9931598414 Enrollment ID: I20211123001325 |
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