Provider Demographics
NPI:1508812801
Name:INTERNAL MEDICINE ASSOCIATES OF EUNICE
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF EUNICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-550-6963
Mailing Address - Street 1:351 MOOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3625
Mailing Address - Country:US
Mailing Address - Phone:337-550-6963
Mailing Address - Fax:337-550-8683
Practice Address - Street 1:351 MOOSA BLVD
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3625
Practice Address - Country:US
Practice Address - Phone:337-550-6963
Practice Address - Fax:337-550-8683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1485080Medicaid
LA1485080Medicaid
LAG85166Medicare UPIN