Healthcare Provider Details

I. General information

NPI: 1144416124
Provider Name (Legal Business Name): US MEDGROUP OF MASSACHUSETTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SHARPE DR
CRANSTON RI
02920-4485
US

IV. Provider business mailing address

5080 SPECTRUM DRIVE SUITE 1200 WEST
ADDISON TX
75001-4625
US

V. Phone/Fax

Practice location:
  • Phone: 800-285-9795
  • Fax: 877-727-6306
Mailing address:
  • Phone: 800-232-3550
  • Fax: 214-775-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. W TOM FOGARTY
Title or Position: EVP, CMO
Credential: MD
Phone: 800-232-3550