Basic Information
Provider Information
NPI: 1730376393
EntityType: 2
ReplacementNPI:  
OrganizationName: U.S. MEDGROUP, P.A .
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
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Mailing Information
Address1: 5080 SPECTRUM DRIVE
Address2: SUITE 1200 WEST
City: ADDISON
State: TX
PostalCode: 750014625
CountryCode: US
TelephoneNumber: 8002323550
FaxNumber: 2147754502
Practice Location
Address1: 2080 SPRINGER DR
Address2:  
City: LOMBARD
State: IL
PostalCode: 601486402
CountryCode: US
TelephoneNumber: 8883782566
FaxNumber: 6309324745
Other Information
ProviderEnumerationDate: 09/27/2007
LastUpdateDate: 09/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HASSETT
AuthorizedOfficialFirstName: ROBERT
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: EVP, CMO
AuthorizedOfficialTelephone: 9723648000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: DO
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QH0100X  Y Ambulatory Health Care FacilitiesClinic/CenterHealth Service

No ID Information.


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