Healthcare Provider Details

I. General information

NPI: 1881002996
Provider Name (Legal Business Name): IMA MEDICAL HOME TEAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 AZALEA DR
OXFORD MS
38655-7900
US

IV. Provider business mailing address

1515 HERITAGE DRIVE SUITE 110
MCKINNEY TX
75069-3379
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-0332
  • Fax:
Mailing address:
  • Phone: 855-860-2109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13540
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13892
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number07454
License Number StateMS

VIII. Authorized Official

Name: MILTON D HOBBS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 662-234-0332