Provider Demographics
NPI:1083888374
Name:NGUYEN MEDICAL GROUP INC
Entity Type:Organization
Organization Name:NGUYEN MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-939-0800
Mailing Address - Street 1:1251 NILLES RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7206
Mailing Address - Country:US
Mailing Address - Phone:513-939-0800
Mailing Address - Fax:513-939-0811
Practice Address - Street 1:1251 NILLES RD
Practice Address - Street 2:STE 6
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7206
Practice Address - Country:US
Practice Address - Phone:513-939-0800
Practice Address - Fax:513-939-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP03271Medicare PIN