MEDICARE: THE INTERNAL MEDICINE CENTER, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	J4716	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548344401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE INTERNAL MEDICINE CENTER, P.A.

Provider Business Mailing Address
First Line	:	2310 DE LEE ST
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-2815
Country	:	US
Telephone Number	:	979-774-0400
Fax Number	:	979-774-8908

Provider Business Practice Location Address
First Line	:	2310 DE LEE ST
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-2815
Country	:	US
Telephone Number	:	979-774-0400
Fax Number	:	979-774-8908

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH CATHERINE BERIGAN
Credential	:	M.D.
Telephone Number	:	979-774-0400

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/02/2012

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