Provider Demographics
NPI:1568287852
Name:MEDFORCE SPECIALISTS MEDICAL GROUP
Entity type:Organization
Organization Name:MEDFORCE SPECIALISTS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JILIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-882-8173
Mailing Address - Street 1:55 S RAYMOND AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-7101
Mailing Address - Country:US
Mailing Address - Phone:860-882-8173
Mailing Address - Fax:
Practice Address - Street 1:55 S RAYMOND AVE STE 105
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-7101
Practice Address - Country:US
Practice Address - Phone:860-882-8173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty