Provider Demographics
NPI:1184938029
Name:P3 MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:P3 MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-619-0407
Mailing Address - Street 1:325 N MAIN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8005
Mailing Address - Country:US
Mailing Address - Phone:937-619-0407
Mailing Address - Fax:937-619-0408
Practice Address - Street 1:325 N MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-8005
Practice Address - Country:US
Practice Address - Phone:937-619-0407
Practice Address - Fax:937-619-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty