Provider Demographics
NPI:1053848549
Name:PROFOUND MEDICAL MANAGEMNT GROUP
Entity Type:Organization
Organization Name:PROFOUND MEDICAL MANAGEMNT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-469-5011
Mailing Address - Street 1:7007 NORTH FWY STE 200B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-1324
Mailing Address - Country:US
Mailing Address - Phone:832-709-0155
Mailing Address - Fax:
Practice Address - Street 1:7007 NORTH FWY STE 200B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-1324
Practice Address - Country:US
Practice Address - Phone:832-709-0155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3124208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty