Provider Demographics
NPI:1083053839
Name:THE MEDIC GROUP, LLC
Entity Type:Organization
Organization Name:THE MEDIC GROUP, LLC
Other - Org Name:MEDIC MASSAGE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STROMEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-550-9933
Mailing Address - Street 1:PO BOX 66328
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-6328
Mailing Address - Country:US
Mailing Address - Phone:505-550-9933
Mailing Address - Fax:505-792-7587
Practice Address - Street 1:6211 SAN MATEO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3533
Practice Address - Country:US
Practice Address - Phone:505-550-9933
Practice Address - Fax:505-792-7587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3804302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization