Provider Demographics
NPI:1578970653
Name:THE MEDEOR GROUP
Entity Type:Organization
Organization Name:THE MEDEOR GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARTCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-788-7283
Mailing Address - Street 1:4519 RINGROSE DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2918
Mailing Address - Country:US
Mailing Address - Phone:832-788-7283
Mailing Address - Fax:
Practice Address - Street 1:4519 RINGROSE DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2918
Practice Address - Country:US
Practice Address - Phone:832-788-7283
Practice Address - Fax:713-300-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00398246ZS0410X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty