Provider Demographics
NPI:1235354754
Name:HMG PSYCHIATRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:HMG PSYCHIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT HMG PSYCHIATRIC ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-639-0400
Mailing Address - Street 1:PO BOX 5567
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-0027
Mailing Address - Country:US
Mailing Address - Phone:804-353-0010
Mailing Address - Fax:804-353-0041
Practice Address - Street 1:5918 HARBOR PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-0027
Practice Address - Country:US
Practice Address - Phone:804-639-0400
Practice Address - Fax:804-639-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03563Medicare UPIN