Provider Demographics
NPI:1568720142
Name:TEAL GROUP, PLLC
Entity Type:Organization
Organization Name:TEAL GROUP, PLLC
Other - Org Name:UNITED MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-437-2400
Mailing Address - Street 1:PO BOX 4150
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-4150
Mailing Address - Country:US
Mailing Address - Phone:606-437-2400
Mailing Address - Fax:606-218-6082
Practice Address - Street 1:50 WEDDINGTON BRANCH RD STE C
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3296
Practice Address - Country:US
Practice Address - Phone:606-437-2400
Practice Address - Fax:606-437-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02802207Q00000X, 207QA0401X
207Q00000X, 363A00000X, 207Q00000X, 207Q00000X
KY031362085R0202X
KY031172085R0202X
KY3009093363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty