Healthcare Provider Details

I. General information

NPI: 1720367923
Provider Name (Legal Business Name): US MEDGROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 BRANCH AVE
PROVIDENCE RI
02904
US

IV. Provider business mailing address

5080 SPECTRUM DRIVE SUITE 1200 WEST
ADDISON TX
75001
US

V. Phone/Fax

Practice location:
  • Phone: 401-722-8880
  • Fax: 401-723-9320
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HASSETT
Title or Position: PRESIDENT
Credential: DO
Phone: 972-364-8000