Provider Demographics
NPI:1619672714
Name:AMG MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:AMG MEDICAL GROUP, LLC
Other - Org Name:AMG MEDICAL GROUP, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:MONROY AVELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-388-5982
Mailing Address - Street 1:2714 REW CIR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2990
Mailing Address - Country:US
Mailing Address - Phone:407-388-5982
Mailing Address - Fax:
Practice Address - Street 1:2714 REW CIR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2990
Practice Address - Country:US
Practice Address - Phone:407-388-5982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty