Provider Demographics
NPI:1558769083
Name:MX MEDICAL GROUP
Entity Type:Organization
Organization Name:MX MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:E
Authorized Official - Last Name:SUMOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-540-9777
Mailing Address - Street 1:2121 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3345
Mailing Address - Country:US
Mailing Address - Phone:561-540-9777
Mailing Address - Fax:
Practice Address - Street 1:2121 10TH AVE N
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3345
Practice Address - Country:US
Practice Address - Phone:561-540-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service