Provider Demographics
NPI:1518013648
Name:INTERNAL MEDICINE ASSOCIATES OF TAYLOR COUNTY, PSC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF TAYLOR COUNTY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:EADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-465-3812
Mailing Address - Street 1:95 KINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9604
Mailing Address - Country:US
Mailing Address - Phone:270-465-3812
Mailing Address - Fax:270-465-8352
Practice Address - Street 1:95 KINGSWOOD DR
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9604
Practice Address - Country:US
Practice Address - Phone:270-465-3812
Practice Address - Fax:270-465-8352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3838Medicare ID - Type Unspecified