Provider Demographics
NPI:1326304718
Name:IMG MEDICAL GROUP
Entity Type:Organization
Organization Name:IMG MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MOXLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-233-1713
Mailing Address - Street 1:365 FERRY ST STE 5
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-5652
Mailing Address - Country:US
Mailing Address - Phone:857-233-1713
Mailing Address - Fax:
Practice Address - Street 1:365 FERRY ST STE 5
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5652
Practice Address - Country:US
Practice Address - Phone:857-233-1713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty