Provider Demographics
NPI:1285199448
Name:INTERNIST CHRONIC CARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:INTERNIST CHRONIC CARE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THIMOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCHALIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-836-3577
Mailing Address - Street 1:206 N 2100 W STE 202
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-4741
Mailing Address - Country:US
Mailing Address - Phone:801-924-8571
Mailing Address - Fax:801-883-8044
Practice Address - Street 1:110 N CONCORD FOREST CIR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-6600
Practice Address - Country:US
Practice Address - Phone:281-836-3577
Practice Address - Fax:801-883-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty