Provider Demographics
NPI:1558800359
Name:OM MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:OM MEDICAL GROUP, P.C.
Other - Org Name:SCOTT MASSEY, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-642-9286
Mailing Address - Street 1:718 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-2605
Mailing Address - Country:US
Mailing Address - Phone:717-495-2323
Mailing Address - Fax:717-326-1611
Practice Address - Street 1:718 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-2605
Practice Address - Country:US
Practice Address - Phone:773-642-9286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458727207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407293772OtherINDIVIDUAL NPI: SCOTT MASSEY, MD