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General NPI Number Information
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NPI Number | 1730370164
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE ASSOCIATES OF COLUMBUS, P.C.
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 425 HOSPITAL DR SUITE 6
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City | COLUMBUS
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State | MS
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Zip | 39705-1901
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Country | US
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Telephone | 662-243-2013
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Fax |
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Provider Business Mailing Address
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Address Line | 425 HOSPITAL DR SUITE 6
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City | COLUMBUS
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State | MS
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Zip | 39705-1901
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Country | US
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Telephone | 662-243-2013
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Fax |
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | JEANIE ANN WRATHER
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Credential |
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Telephone | 662-243-2013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | MS
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