Provider Demographics
NPI:1659819647
Name:TEAL GROUP PLLC
Entity type:Organization
Organization Name:TEAL GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-437-2400
Mailing Address - Street 1:258 NORTH LEVISA ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUTHCARD
Mailing Address - State:KY
Mailing Address - Zip Code:41548-8331
Mailing Address - Country:US
Mailing Address - Phone:606-437-2400
Mailing Address - Fax:606-437-2401
Practice Address - Street 1:50 WEDDINGTON BRANCH RD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3296
Practice Address - Country:US
Practice Address - Phone:606-437-2400
Practice Address - Fax:606-437-2401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED MEDICAL GROUP BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-09
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103079101YA0400X, 101YP2500X
KY02802207QA0401X
KY02861207QA0401X
KY3009093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty