Basic Information
| Provider Information | |||||||||
| NPI: | 1407064488 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RELIANT MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 FRONT ST, WOT 12TH FL | ||||||||
| Address2: | ATTN: MEDICAL STAFF SERVICES | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016081425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083685424 | ||||||||
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| Practice Location | |||||||||
| Address1: | 135 GOLD STAR BLVD | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088520600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 01/30/2012 | ||||||||
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| AuthorizedOfficialLastName: | RICHMAN | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5088520600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.