Provider Demographics
NPI:1568619005
Name:IMED HEALTHCARE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:IMED HEALTHCARE ASSOCIATES, PLLC
Other - Org Name:IMED INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-575-8505
Mailing Address - Street 1:255 E SONTERRA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4076
Mailing Address - Country:US
Mailing Address - Phone:210-404-0000
Mailing Address - Fax:210-404-2813
Practice Address - Street 1:255 E SONTERRA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4076
Practice Address - Country:US
Practice Address - Phone:210-404-0000
Practice Address - Fax:210-404-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DO3578OtherMEDICARE RR
TXH00019RT01OtherBCBS
TX197507001Medicaid
TX197507001Medicaid