Basic Information
| Provider Information | |||||||||
| NPI: | 1528131893 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MUSKINGUM MEDICAL GROUP, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3777 JAMES CT | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437018127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404535003 | ||||||||
| FaxNumber: | 7404528826 | ||||||||
| Practice Location | |||||||||
| Address1: | 3777 JAMES CT | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437018127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404535003 | ||||||||
| FaxNumber: | 7404528826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 01/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | RAUL | ||||||||
| AuthorizedOfficialMiddleName: | ALBERTO | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7404535003 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.