Provider Demographics
NPI:1114987781
Name:INTERNAL MEDICINE GROUP, PA
Entity Type:Organization
Organization Name:INTERNAL MEDICINE GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:RABY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-728-0112
Mailing Address - Street 1:415 N CENTER ST
Mailing Address - Street 2:SUITE 001
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5036
Mailing Address - Country:US
Mailing Address - Phone:828-322-9199
Mailing Address - Fax:828-322-6424
Practice Address - Street 1:415 N CENTER ST
Practice Address - Street 2:SUITE 001
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5036
Practice Address - Country:US
Practice Address - Phone:828-322-9199
Practice Address - Fax:828-322-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56942174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02380OtherBCBS OF NC
NC7902380Medicaid
NC2315601Medicare ID - Type Unspecified