Basic Information
| Provider Information | |||||||||
| NPI: | 1548582778 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITALMD OF TROY IP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 WESTPARK CT | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | PEACHTREE CITY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302693571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706318478 | ||||||||
| FaxNumber: | 7706318473 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E CHERRY ST | ||||||||
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| City: | TROY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633791513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6365288551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2010 | ||||||||
| LastUpdateDate: | 02/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | BURNETTE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7706318478 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.