Provider Demographics
NPI:1316197957
Name:MEDICAL ASSOCIATES GROUP INC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-304-5719
Mailing Address - Street 1:228 GUNBARREL ROAD STE 111
Mailing Address - Street 2:SUITE 192
Mailing Address - City:CATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-304-5719
Mailing Address - Fax:
Practice Address - Street 1:228 GUNBARREL ROAD STE 111
Practice Address - Street 2:SUITE 192
Practice Address - City:CATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-304-5719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty