Provider Demographics
NPI:1255759965
Name:BOSTON MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:BOSTON MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:QUOC
Authorized Official - Middle Name:H
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-735-8451
Mailing Address - Street 1:999 PONCE DE LEON BLVD.
Mailing Address - Street 2:SUITE 740
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-448-5515
Mailing Address - Fax:305-448-5131
Practice Address - Street 1:999 PONCE DE LEON BLVD.
Practice Address - Street 2:SUITE 740
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-448-5515
Practice Address - Fax:305-448-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty