Provider Demographics
NPI:1548457161
Name:NATIONAL MEDICAL GROUP
Entity type:Organization
Organization Name:NATIONAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNEDY
Authorized Official - Middle Name:T
Authorized Official - Last Name:OBANOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-216-2555
Mailing Address - Street 1:13619 TONNOCHY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6042
Mailing Address - Country:US
Mailing Address - Phone:713-776-9674
Mailing Address - Fax:281-667-3142
Practice Address - Street 1:551 STATE ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-5133
Practice Address - Country:US
Practice Address - Phone:409-489-0505
Practice Address - Fax:281-667-3142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center