Provider Demographics
NPI:1275506867
Name:INTERNISTS OF ANDERSON, INC
Entity Type:Organization
Organization Name:INTERNISTS OF ANDERSON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:POPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-231-2006
Mailing Address - Street 1:PO BOX 640609
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-0609
Mailing Address - Country:US
Mailing Address - Phone:513-231-2006
Mailing Address - Fax:513-624-2994
Practice Address - Street 1:7426 JAGER CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4344
Practice Address - Country:US
Practice Address - Phone:513-231-2006
Practice Address - Fax:513-624-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2008213Medicaid
OHCB4646OtherRR MCR
OH9265531Medicare PIN