Provider Demographics
NPI:1841489614
Name:ACCUMED MEDISPA,LLC
Entity type:Organization
Organization Name:ACCUMED MEDISPA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MAGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-441-1104
Mailing Address - Street 1:333 N RIVERSHIRE DR STE 290
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3100
Mailing Address - Country:US
Mailing Address - Phone:936-441-1104
Mailing Address - Fax:936-756-3360
Practice Address - Street 1:333 N RIVERSHIRE DR STE 290
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3100
Practice Address - Country:US
Practice Address - Phone:936-441-1104
Practice Address - Fax:936-756-3360
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGGIO INTERNATIONAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty