Provider Demographics
NPI:1265685515
Name:INTERNATIONAL MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:INTERNATIONAL MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EUN
Authorized Official - Middle Name:HEE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-642-1004
Mailing Address - Street 1:5410 PORT ROYAL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-2314
Mailing Address - Country:US
Mailing Address - Phone:703-642-1004
Mailing Address - Fax:703-642-3232
Practice Address - Street 1:5410 PORT ROYAL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-2314
Practice Address - Country:US
Practice Address - Phone:703-642-1004
Practice Address - Fax:703-642-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101052584208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty