MEDICARE: INTERNAL MEDICINE ASSOCIATES LLP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588658892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE ASSOCIATES LLP

Provider Business Mailing Address
First Line	:	5502 39TH ST
Second Line	:	#105
City	:	GROVES
State	:	TX
Zip	:	77619-2929
Country	:	US
Telephone Number	:	409-962-7606
Fax Number	:	409-962-6027

Provider Business Practice Location Address
First Line	:	5502 39TH ST
Second Line	:	#105
City	:	GROVES
State	:	TX
Zip	:	77619-2929
Country	:	US
Telephone Number	:	409-962-7606
Fax Number	:	409-962-6027

Authorized Official
Title or Position	:	50 PARTNER OF LLP
Name	:	ROUSSEL CLEMENT
Credential	:	MD
Telephone Number	:	409-962-7606

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/21/2022

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