Provider Demographics
NPI:1619920154
Name:MAIDEN MEDICALGROUP, INC
Entity type:Organization
Organization Name:MAIDEN MEDICALGROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-428-0490
Mailing Address - Street 1:510 ISLAND FORD RD
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-8741
Mailing Address - Country:US
Mailing Address - Phone:828-428-0490
Mailing Address - Fax:828-428-0906
Practice Address - Street 1:510 ISLAND FORD RD
Practice Address - Street 2:
Practice Address - City:MAIDEN
Practice Address - State:NC
Practice Address - Zip Code:28650-8741
Practice Address - Country:US
Practice Address - Phone:828-428-0490
Practice Address - Fax:828-428-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2203456Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NCC69448Medicare UPIN
NCC69449Medicare UPIN