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General NPI Number Information
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NPI Number | 1609530013
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Entity Type | Organization
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Legal Business Name | M MEDICAL GROUP SE LLC
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Dates
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Enumeration Date | 10/22/2021
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 121 COMMONS DR
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City | ATHENS
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State | TX
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Zip | 75751-0009
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Country | US
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Telephone | 903-677-3434
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Fax |
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Provider Business Mailing Address
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Address Line | 6 E EAGER ST
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City | BALTIMORE
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State | MD
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Zip | 21202-2506
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Country | US
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Telephone | 888-307-2425
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Fax | 412-729-5060
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MELISSA REEP
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Credential |
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Telephone | 888-307-2425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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