Healthcare Provider Details

I. General information

NPI: 1295787505
Provider Name (Legal Business Name): INTERNAL MEDICINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MEMORIAL HOSPITAL DR SUITE 200
MOBILE AL
36608-1786
US

IV. Provider business mailing address

101 MEMORIAL HOSPITAL DR #200
MOBILE AL
36608-1786
US

V. Phone/Fax

Practice location:
  • Phone: 251-414-5900
  • Fax: 251-281-1162
Mailing address:
  • Phone: 251-414-5900
  • Fax: 251-281-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN C FREEMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 251-414-5900