1144416124 NPI number — US MEDGROUP OF MASSACHUSETTS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144416124 NPI number — US MEDGROUP OF MASSACHUSETTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
US MEDGROUP OF MASSACHUSETTS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144416124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5080 SPECTRUM DRIVE
Provider Second Line Business Mailing Address:
SUITE 1200 WEST
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-4625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-232-3550
Provider Business Mailing Address Fax Number:
214-775-4502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 SHARPE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02920-4485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-285-9795
Provider Business Practice Location Address Fax Number:
877-727-6306
Provider Enumeration Date:
09/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FOGARTY
Authorized Official First Name:
W
Authorized Official Middle Name:
TOM
Authorized Official Title or Position:
EVP, CMO
Authorized Official Telephone Number:
800-232-3550

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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