Provider Demographics
NPI:1487824058
Name:INTERNAL MEDICINE AFFILIATES
Entity Type:Organization
Organization Name:INTERNAL MEDICINE AFFILIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MATHEWS
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-786-1025
Mailing Address - Street 1:516 TUSCALOOSA AVE SW
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1631
Mailing Address - Country:US
Mailing Address - Phone:205-786-1025
Mailing Address - Fax:205-780-0670
Practice Address - Street 1:516 TUSCALOOSA AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1631
Practice Address - Country:US
Practice Address - Phone:205-786-1025
Practice Address - Fax:205-780-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529920170Medicaid
AL051520583Medicare PIN