Provider Demographics
NPI:1811181316
Name:MD & ASSOCIATES, INC.
Entity type:Organization
Organization Name:MD & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL BIILING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOFFIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-476-7679
Mailing Address - Street 1:14189 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 107B
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3093
Mailing Address - Country:US
Mailing Address - Phone:909-476-7679
Mailing Address - Fax:909-476-0777
Practice Address - Street 1:14189 FOOTHILL BLVD
Practice Address - Street 2:107B
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3093
Practice Address - Country:US
Practice Address - Phone:909-476-7679
Practice Address - Fax:951-572-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD08604467OtherEDI SUBMITTER ID