Provider Demographics
NPI:1285688952
Name:INTERNAL MEDICINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:GEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-342-2521
Mailing Address - Street 1:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-0907
Mailing Address - Country:US
Mailing Address - Phone:620-342-2521
Mailing Address - Fax:620-342-6520
Practice Address - Street 1:1301 W 12TH AVE
Practice Address - Street 2:STE 202
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-0907
Practice Address - Country:US
Practice Address - Phone:620-342-2521
Practice Address - Fax:620-342-6520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100303290AMedicaid
KS1103781NMedicare ID - Type Unspecified