Provider Demographics
NPI:1003831686
Name:PHYSICIANS OF INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:PHYSICIANS OF INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JJOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-397-5236
Mailing Address - Street 1:7710 MERCY RD STE 601
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2365
Mailing Address - Country:US
Mailing Address - Phone:402-397-5236
Mailing Address - Fax:402-397-8864
Practice Address - Street 1:7710 MERCY RD STE 601
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2365
Practice Address - Country:US
Practice Address - Phone:402-397-5236
Practice Address - Fax:402-397-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE07724OtherBLUE CROSS BLUE SHIELD NE
NECH0514OtherRAILROAD MEDICARE
NECH0514OtherRAILROAD MEDICARE
NECH0514OtherRAILROAD MEDICARE