Provider Demographics
NPI:1356495204
Name:HOSPITAL INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:HOSPITAL INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-213-3423
Mailing Address - Street 1:1510 NW 107TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-5768
Mailing Address - Country:US
Mailing Address - Phone:352-332-3893
Mailing Address - Fax:
Practice Address - Street 1:6500 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4309
Practice Address - Country:US
Practice Address - Phone:352-332-3893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264009100Medicaid