Basic Information
| Provider Information | |||||||||
| NPI: | 1912458662 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | U.S. HEALTHWORKS MEDICAL GROUP OF INDIANA, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25124 SPRINGFIELD CT | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913551085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616782600 | ||||||||
| FaxNumber: | 6616782700 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 E BEARDSLEY AVE | ||||||||
| Address2: | SUITE100 | ||||||||
| City: | ELKHART | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465143366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742068010 | ||||||||
| FaxNumber: | 5742669438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2016 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | MALLAS | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6616782600 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | U.S HEALTHWORKS MEDICAL GROUP OF INDIANA, PC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.