MEDICARE: INSTITUTIONAL MEDICAL ASSOCIATES, INC

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
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1205043890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTIONAL MEDICAL ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	6525 W CAMPUS OVAL
Second Line	:	SUITE 150
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-8830
Country	:	US
Telephone Number	:	614-781-4138
Fax Number	:	614-781-4139

Provider Business Practice Location Address
First Line	:	6172 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-1614
Country	:	US
Telephone Number	:	614-882-7131
Fax Number	:	614-882-7138

Authorized Official
Title or Position	:	OWNER
Name	:	LEWIS W COPPEL JR.
Credential	:	M.D.
Telephone Number	:	614-880-5330

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	06/24/2008

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