Provider Demographics
NPI:1760890347
Name:ASSOCIATED MD GROUP
Entity Type:Organization
Organization Name:ASSOCIATED MD GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-440-4849
Mailing Address - Street 1:501 WILDWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-5262
Mailing Address - Country:US
Mailing Address - Phone:239-440-4849
Mailing Address - Fax:
Practice Address - Street 1:501 WILDWOOD PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5262
Practice Address - Country:US
Practice Address - Phone:239-440-4849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty