Provider Demographics
NPI:1053302703
Name:JEFFERSON INTERNAL MEDICINE ASSOCIATES, LTD
Entity Type:Organization
Organization Name:JEFFERSON INTERNAL MEDICINE ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-342-1007
Mailing Address - Street 1:1111 S JEFFERSON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4724
Mailing Address - Country:US
Mailing Address - Phone:540-342-1007
Mailing Address - Fax:540-345-4643
Practice Address - Street 1:1111 S JEFFERSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4724
Practice Address - Country:US
Practice Address - Phone:540-342-1007
Practice Address - Fax:540-345-4643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
072204OtherANTHEM
3374958OtherCIGNA
3374958OtherCIGNA