Provider Demographics
NPI:1144416124
Name:US MEDGROUP OF MASSACHUSETTS PC
Entity Type:Organization
Organization Name:US MEDGROUP OF MASSACHUSETTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, CMO
Authorized Official - Prefix:MR
Authorized Official - First Name:W
Authorized Official - Middle Name:TOM
Authorized Official - Last Name:FOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-232-3550
Mailing Address - Street 1:5080 SPECTRUM DRIVE
Mailing Address - Street 2:SUITE 1200 WEST
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4625
Mailing Address - Country:US
Mailing Address - Phone:800-232-3550
Mailing Address - Fax:214-775-4502
Practice Address - Street 1:40 SHARPE DR
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4485
Practice Address - Country:US
Practice Address - Phone:800-285-9795
Practice Address - Fax:877-727-6306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service