Provider Demographics
NPI:1407064488
Name:RELIANT MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:RELIANT MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-852-0600
Mailing Address - Street 1:100 FRONT ST, WOT 12TH FL
Mailing Address - Street 2:ATTN: MEDICAL STAFF SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1425
Mailing Address - Country:US
Mailing Address - Phone:508-368-5424
Mailing Address - Fax:
Practice Address - Street 1:135 GOLD STAR BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2738
Practice Address - Country:US
Practice Address - Phone:508-852-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier