Provider Demographics
NPI:1114130606
Name:INTERNAL MEDICINE ASSOCIATES OF FRANKFORT, PSC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF FRANKFORT, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-227-7538
Mailing Address - Street 1:101 MEDICAL HEIGHTS DR
Mailing Address - Street 2:SUITE M
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4137
Mailing Address - Country:US
Mailing Address - Phone:502-227-7538
Mailing Address - Fax:502-227-9248
Practice Address - Street 1:101 MEDICAL HEIGHTS DR
Practice Address - Street 2:SUITE M
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4137
Practice Address - Country:US
Practice Address - Phone:502-227-7538
Practice Address - Fax:502-227-9248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC30629OtherGROUP MEDICARE RAILROAD
KY65934895Medicaid
KY65934895Medicaid