Provider Demographics
NPI:1881676187
Name:USA MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:USA MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-758-6220
Mailing Address - Street 1:1450 IDLEWILD CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-3239
Mailing Address - Country:US
Mailing Address - Phone:941-758-6220
Mailing Address - Fax:941-758-8963
Practice Address - Street 1:1450 IDLEWILD CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-3239
Practice Address - Country:US
Practice Address - Phone:941-758-6220
Practice Address - Fax:941-758-8963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR8450OtherBLUE CROSS BLUE SHIELD
FL57688OtherNORTHWOOD NPN PROV #
FL1088650001Medicare NSC