Provider Demographics
NPI: | 1033766092 |
---|---|
Name: | OSH-MI PHYSICIANS GROUP PC |
Entity Type: | Organization |
Organization Name: | OSH-MI PHYSICIANS GROUP PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CMO |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | GRIFFIN |
Authorized Official - Middle Name: | ROBERT |
Authorized Official - Last Name: | MYERS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 307-264-2085 |
Mailing Address - Street 1: | 30 W MONROE ST STE 1200 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60603-2420 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 312-733-9730 |
Mailing Address - Fax: | 773-866-8014 |
Practice Address - Street 1: | 1007 SUMMIT AVE |
Practice Address - Street 2: | |
Practice Address - City: | GREENSBORO |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27405-7007 |
Practice Address - Country: | US |
Practice Address - Phone: | 336-200-7010 |
Practice Address - Fax: | 704-710-8592 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | OSH MI PHYSICIANS GROUP PC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2019-08-23 |
Last Update Date: | 2023-06-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 207QG0300X | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | Group - Multi-Specialty |
No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | Group - Multi-Specialty |
No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
No | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | Group - Multi-Specialty |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 2017-00292 | Other | LICENSE NUMBER |