Provider Demographics
NPI:1467532408
Name:INTERNAL MEDICINE CARE, INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TYNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-429-0607
Mailing Address - Street 1:2510 COMMONS BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3820
Mailing Address - Country:US
Mailing Address - Phone:937-429-0607
Mailing Address - Fax:937-558-3067
Practice Address - Street 1:450B WASHINGTON JACKSON RD
Practice Address - Street 2:SUITE 112
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-7600
Practice Address - Country:US
Practice Address - Phone:937-429-0607
Practice Address - Fax:937-558-3067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9248835Medicare PIN