MEDICARE: INTERNAL MEDICINE CLINIC, LTD

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	35077256	OH

General Provider Information

NPI Number	:	1659467512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE CLINIC, LTD

Provider Business Mailing Address
First Line	:	335 OXFORD ST
Second Line	:	SUITE C
City	:	DOVER
State	:	OH
Zip	:	44622-1970
Country	:	US
Telephone Number	:	330-364-7551
Fax Number	:	330-364-7553

Provider Business Practice Location Address
First Line	:	335 OXFORD ST STE C
Second Line	:
City	:	DOVER
State	:	OH
Zip	:	44622-1970
Country	:	US
Telephone Number	:	330-364-7551
Fax Number	:	330-364-7553

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. NANCY J AUSTIN
Credential	:
Telephone Number	:	330-364-7551

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	01/13/2010

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