Provider Demographics
NPI:1326890336
Name:MGH MEDICAL GROUP OH LLC
Entity Type:Organization
Organization Name:MGH MEDICAL GROUP OH LLC
Other - Org Name:MGH MEDICAL GROUP OH LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CRCO-REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEMINISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLORZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-667-5465
Mailing Address - Street 1:515 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4109
Mailing Address - Country:US
Mailing Address - Phone:954-667-5465
Mailing Address - Fax:412-451-8656
Practice Address - Street 1:515 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4109
Practice Address - Country:US
Practice Address - Phone:954-667-5465
Practice Address - Fax:412-451-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty