Healthcare Provider Details

I. General information

NPI: 1205043890
Provider Name (Legal Business Name): INSTITUTIONAL MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6172 CLEVELAND AVE
COLUMBUS OH
43231-1614
US

IV. Provider business mailing address

6525 W CAMPUS OVAL SUITE 150
NEW ALBANY OH
43054-8830
US

V. Phone/Fax

Practice location:
  • Phone: 614-882-7131
  • Fax: 614-882-7138
Mailing address:
  • Phone: 614-781-4138
  • Fax: 614-781-4139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LEWIS W COPPEL JR.
Title or Position: OWNER
Credential: M.D.
Phone: 614-880-5330