Provider Demographics
NPI:1376553990
Name:INTERNAL MEDICINE ASSOCIATES INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-943-1300
Mailing Address - Street 1:1150 RESERVOIR AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920
Mailing Address - Country:US
Mailing Address - Phone:401-943-1300
Mailing Address - Fax:401-946-8480
Practice Address - Street 1:1150 RESERVOIR AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920
Practice Address - Country:US
Practice Address - Phone:401-943-1300
Practice Address - Fax:401-946-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIIM02288Medicaid
RI109000816Medicare PIN
RI109000816Medicare ID - Type Unspecified