Organization
MED 1ST OF EVANSVILLE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN EDWARD POELING D.C. (PRESIDENT)
(812) 473-4011
Entity
Organization
Contact information
Practice address
1401 WASHINGTON AVE, EVANSVILLE, IN 47714-2056
(812) 473-4011
(812) 474-4581
Mailing address
PO BOX 4506, EVANSVILLE, IN 47724-0506
(812) 473-4011
(812) 474-4581
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
156619
MEDICARE OUTPATIENT REHAB FACILITY
IN
01
—
5358340001
DMERC PTAN
IN
Enumeration date
06/21/2006
Last updated
11/20/2008
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