Provider Demographics
NPI:1588680946
Name:PARTNERS IN INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:PARTNERS IN INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-363-7707
Mailing Address - Street 1:123 SUMMER ST
Mailing Address - Street 2:SUITE 370N
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1216
Mailing Address - Country:US
Mailing Address - Phone:508-363-7300
Mailing Address - Fax:508-363-7300
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 370 N
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-7300
Practice Address - Fax:508-363-9688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9761021Medicaid
MAG88479Medicare UPIN
MA9761021Medicaid