Provider Demographics
NPI:1316471402
Name:COMP LEGAL MEDICAL GROUP
Entity type:Organization
Organization Name:COMP LEGAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TENIEJA
Authorized Official - Middle Name:QYNN
Authorized Official - Last Name:NARCISSE-PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-560-3113
Mailing Address - Street 1:PO BOX 1885
Mailing Address - Street 2:
Mailing Address - City:SUTTER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95685-1885
Mailing Address - Country:US
Mailing Address - Phone:209-560-3113
Mailing Address - Fax:866-999-3744
Practice Address - Street 1:71 BRYSON DR
Practice Address - Street 2:
Practice Address - City:SUTTER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95685-4115
Practice Address - Country:US
Practice Address - Phone:209-560-3113
Practice Address - Fax:866-999-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty