Healthcare Provider Details

I. General information

NPI: 1730713967
Provider Name (Legal Business Name): INTERNAL MEDICINE PRIMARY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W MARKET ST STE 210A
LIMA OH
45805-2777
US

IV. Provider business mailing address

920 W MARKET ST STE 210A
LIMA OH
45805-2777
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-7770
  • Fax: 419-229-8258
Mailing address:
  • Phone: 419-227-7770
  • Fax: 419-229-8258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANE SWARTZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 419-229-3362