MEDICARE: INTERNAL MEDICINE ASSOCIATES OF SOUTH TEXAS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	N3283	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	N3283	OTHER	TX	PHYSICIAN PERMIT

General Provider Information

NPI Number	:	1104150119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE ASSOCIATES OF SOUTH TEXAS, PLLC

Provider Business Mailing Address
First Line	:	320 MERCEDES ST
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-2593
Country	:	US
Telephone Number	:	817-249-7323
Fax Number	:	817-887-2193

Provider Business Practice Location Address
First Line	:	320 MERCEDES ST
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-2593
Country	:	US
Telephone Number	:	817-249-7323
Fax Number	:	817-887-2193

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RUBIA SADIQ
Credential	:	MD
Telephone Number	:	817-249-7323

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	04/12/2016

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