Provider Demographics
NPI:1477805489
Name:COLUMBIA MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:COLUMBIA MEDICAL GROUP LLC
Other - Org Name:BARCLAY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ MESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-200-0047
Mailing Address - Street 1:2240 W WOOLBRIGHT RD
Mailing Address - Street 2:SUITE 317
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6332
Mailing Address - Country:US
Mailing Address - Phone:561-200-0047
Mailing Address - Fax:561-200-0067
Practice Address - Street 1:2938 S JOG RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2002
Practice Address - Country:US
Practice Address - Phone:561-432-3455
Practice Address - Fax:561-432-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty