Provider Demographics
NPI:1457969859
Name:RICHMOND MEDICAL GROUP INC
Entity Type:Organization
Organization Name:RICHMOND MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:FIDELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSIFO-SELORMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-233-8950
Mailing Address - Street 1:1407 MUSTANG LAKE COURT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406
Mailing Address - Country:US
Mailing Address - Phone:603-233-8950
Mailing Address - Fax:
Practice Address - Street 1:1407 MUSTANG LAKE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-7961
Practice Address - Country:US
Practice Address - Phone:603-233-8950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1568970614Medicaid