MEDICARE: INTERNAL MEDICINE ASSOCIATES OF SOUTH TEXAS PLLC

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	174400000X	Specialist	N3283	TX

General Provider Information

NPI Number	:	1861824567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE ASSOCIATES OF SOUTH TEXAS PLLC

Provider Business Mailing Address
First Line	:	6909 VISTA RIDGE CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4553
Country	:	US
Telephone Number	:	214-597-0195
Fax Number	:

Provider Business Practice Location Address
First Line	:	7800 OAKMONT BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76132-4203
Country	:	US
Telephone Number	:	917-680-9728
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	JIMMY ESTRADA
Credential	:
Telephone Number	:	214-597-0195

Provider Enumeration Date	:	08/05/2013
Last Update Date	:	08/05/2013

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