Physician Management Services of Indiana II, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PHYSICIAN MANAGEMENT SERVICES OF INDIANA II, LLC

Practice address

300 S Saint Louis Blvd Ste 204
South Bend, IN 46617-3044

Phone

(888) 829-8550

NPI assigned

Apr 28, 2021

Last updated

Apr 28, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

VAXCARE CORPORATIONAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brett Kenefick

Title

President

Phone

(888) 829-8550

Specialties & licenses 1

Addresses

Part of

Vaxcare LLC

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619568000000",
    "number": "1053993014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3113 LAWTON RD STE 250",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328033517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S SAINT LOUIS BLVD STE 204",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466173044",
            "telephone_number": "888-829-8550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN MANAGEMENT SERVICES OF INDIANA II, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VAXCARE CORPORATION",
        "enumeration_date": "2021-04-28",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A",
        "authorized_official_last_name": "KENEFICK",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "888-829-8550"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Jordyn Phillips
• Joann Lynn Phillips, M.S.W., L.S.W.
• Katelind Scarlett Phillips, CRNA
• Stacey Phipps
• Physical Medicine & Rehabilitation Specialists PC
• Physicians Holistic Health Alliance, LLC
• Ludmila Pichugena-Emerson, NP-C
• Abigail Piechnik
• Doreen Cynthia Pienkowski, RDH
• Jennifer Pilcher, OTR

• Family Medicine Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.