Provider Demographics
NPI:1114653334
Name:HOSPITALITY MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:HOSPITALITY MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:KALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:BARROWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-518-5164
Mailing Address - Street 1:36 N DETROIT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2963
Mailing Address - Country:US
Mailing Address - Phone:513-518-5164
Mailing Address - Fax:
Practice Address - Street 1:36 N DETROIT ST STE 101
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2963
Practice Address - Country:US
Practice Address - Phone:513-518-5164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty