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General NPI Number Information
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NPI Number | 1417974999
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE ASSOCIATES
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 4318 5TH AVE
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City | MARIANNA
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State | FL
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Zip | 32446-2182
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Country | US
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Telephone | 850-526-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 4250 HOSPITAL DR
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City | MARIANNA
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State | FL
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Zip | 32446-1917
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Country | US
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Telephone | 850-526-5300
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Fax |
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Authorized Official
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Title or Position | INSURANCE SPECIALIST
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Name | MRS. YVONNE HART
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Credential |
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Telephone | 850-526-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | FL
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