Provider Demographics
NPI:1376614362
Name:KROHN INTERNAL MEDICINE ASSOCIATION
Entity Type:Organization
Organization Name:KROHN INTERNAL MEDICINE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:KROHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-632-8220
Mailing Address - Street 1:10 MEDICAL CENTER BLVD, STE. E
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904
Mailing Address - Country:US
Mailing Address - Phone:936-632-8220
Mailing Address - Fax:936-632-8230
Practice Address - Street 1:10 MEDICAL CENTER BLVD STE E
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3163
Practice Address - Country:US
Practice Address - Phone:936-632-8220
Practice Address - Fax:936-632-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8186207R00000X
TXH8185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084066201Medicaid
TX084066201Medicaid
TX1376614362Medicare PIN