Provider Demographics
NPI:1720635790
Name:OSH MI PHYSICIANS GROUP, PC
Entity Type:Organization
Organization Name:OSH MI PHYSICIANS GROUP, PC
Other - Org Name:OSH TN PHYSICIANS GROUP, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:GRIFFIN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-264-2085
Mailing Address - Street 1:PO BOX 746725
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6725
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:3360 N WATKINS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6432
Practice Address - Country:US
Practice Address - Phone:901-401-7150
Practice Address - Fax:901-347-1285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSH MI PHYSICIANS GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-23
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN59583OtherMEDICAL LICENSE