Provider Demographics
NPI:1033617824
Name:MGG AND GROUPS
Entity Type:Organization
Organization Name:MGG AND GROUPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY-GRACE
Authorized Official - Middle Name:G
Authorized Official - Last Name:GAERLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-434-5114
Mailing Address - Street 1:2255 RENAISSANCE DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6751
Mailing Address - Country:US
Mailing Address - Phone:702-434-5114
Mailing Address - Fax:
Practice Address - Street 1:2255 RENAISSANCE DR STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6751
Practice Address - Country:US
Practice Address - Phone:702-434-5114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty