Provider Demographics
NPI:1548245178
Name:IMED INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:IMED INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MDFACP
Authorized Official - Phone:210-404-0000
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78293-0867
Mailing Address - Country:US
Mailing Address - Phone:210-404-0000
Mailing Address - Fax:210-581-0120
Practice Address - Street 1:255 E SONTERRA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3990
Practice Address - Country:US
Practice Address - Phone:210-404-0000
Practice Address - Fax:210-581-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
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
TX0051EBOtherBLUE CROSS IDENTIFIER
TX00532NMedicare ID - Type Unspecified