| NPI | 1508135005 |
|---|---|
| Doing Business As | NORTHEAST REGIONAL MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | PAULA M LALOR Director/Delegated Official 629-215-3953 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2021-04-08 |