Provider Demographics
NPI:1144204991
Name:INTERNAL MEDICINE OF LAKE CITY , PA
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF LAKE CITY , PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7625
Mailing Address - Street 1:334 SW COMMERCE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1502
Mailing Address - Country:US
Mailing Address - Phone:386-755-1703
Mailing Address - Fax:386-755-1744
Practice Address - Street 1:334 SW COMMERCE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1502
Practice Address - Country:US
Practice Address - Phone:386-755-1703
Practice Address - Fax:386-755-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty