Provider Demographics
NPI:1568617819
Name:MEDAMERICA GROUP
Entity Type:Organization
Organization Name:MEDAMERICA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:913-963-8535
Mailing Address - Street 1:8602 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-1410
Mailing Address - Country:US
Mailing Address - Phone:609-822-1604
Mailing Address - Fax:609-822-1604
Practice Address - Street 1:6309 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2295
Practice Address - Country:US
Practice Address - Phone:609-823-0555
Practice Address - Fax:609-823-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-27
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center