Provider Demographics
NPI:1356605588
Name:HYBRID MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:HYBRID MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:NWUMEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-200-0212
Mailing Address - Street 1:3061 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5903
Mailing Address - Country:US
Mailing Address - Phone:309-200-0212
Mailing Address - Fax:309-736-3360
Practice Address - Street 1:3061 7TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5903
Practice Address - Country:US
Practice Address - Phone:309-200-0212
Practice Address - Fax:309-736-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty