Provider Demographics
NPI:1205043890
Name:INSTITUTIONAL MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:INSTITUTIONAL MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:COPPEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:614-880-5330
Mailing Address - Street 1:6525 W CAMPUS OVAL
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8830
Mailing Address - Country:US
Mailing Address - Phone:614-781-4138
Mailing Address - Fax:614-781-4139
Practice Address - Street 1:6172 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-1614
Practice Address - Country:US
Practice Address - Phone:614-882-7131
Practice Address - Fax:614-882-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty