Provider Demographics
NPI:1053703801
Name:ATLAS MEDICAL GROUP, INC
Entity type:Organization
Organization Name:ATLAS MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-489-6784
Mailing Address - Street 1:2350 E GERMANN RD
Mailing Address - Street 2:STE 31
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1579
Mailing Address - Country:US
Mailing Address - Phone:480-878-5306
Mailing Address - Fax:480-320-1391
Practice Address - Street 1:2350 E GERMANN RD
Practice Address - Street 2:STE 31
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-1579
Practice Address - Country:US
Practice Address - Phone:480-878-5306
Practice Address - Fax:480-320-1391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty