MEDICARE: GIRARD INTERNAL MEDICINE LLC

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	261QP2300X	Primary Care Clinic/Center	OS013278	PA

General Provider Information

NPI Number	:	1285875435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIRARD INTERNAL MEDICINE LLC

Provider Business Mailing Address
First Line	:	2625 W GIRARD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1333
Country	:	US
Telephone Number	:	215-724-0517
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 W GIRARD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1333
Country	:	US
Telephone Number	:	215-724-0517
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. NICOLE ARCURI KIMZEY
Credential	:	D.O.
Telephone Number	:	215-724-0517

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	03/18/2009

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