Provider Demographics
NPI:1073984050
Name:MEDICAL RESOURCE GROUP LLC
Entity Type:Organization
Organization Name:MEDICAL RESOURCE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-490-1224
Mailing Address - Street 1:3224 RAINBOW DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-6202
Mailing Address - Country:US
Mailing Address - Phone:256-312-8712
Mailing Address - Fax:256-312-8714
Practice Address - Street 1:3224 RAINBOW DR
Practice Address - Street 2:SUITE 5
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-6202
Practice Address - Country:US
Practice Address - Phone:256-312-8712
Practice Address - Fax:256-312-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty