Provider Demographics
NPI:1114913936
Name:INTERNAL MEDICINE DIAGNOSTICS INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NIRMAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DVM, MSC
Authorized Official - Phone:870-257-5118
Mailing Address - Street 1:197 HOSPITAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHEROKEE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72529-7314
Mailing Address - Country:US
Mailing Address - Phone:870-257-5118
Mailing Address - Fax:
Practice Address - Street 1:197 HOSPITAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:CHEROKEE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:72529-7314
Practice Address - Country:US
Practice Address - Phone:870-257-5118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARX46053Medicare UPIN
AR5C283Medicare ID - Type UnspecifiedCLINIC PROVIDER NUMBER