Provider Demographics
NPI:1144106667
Name:RENAISSANCE MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:RENAISSANCE MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:D
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-420-2311
Mailing Address - Street 1:11-15 SANDERSDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-2855
Mailing Address - Country:US
Mailing Address - Phone:774-420-2311
Mailing Address - Fax:508-519-0763
Practice Address - Street 1:11-15 SANDERSDALE ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-2855
Practice Address - Country:US
Practice Address - Phone:774-420-2311
Practice Address - Fax:508-519-0763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No251E00000XAgenciesHome Health
No333600000XSuppliersPharmacy
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No342000000XTransportation ServicesTransportation Network Company