Provider Demographics
NPI:1639109366
Name:INTEGRATED MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HAWKINS
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:207-680-2070
Mailing Address - Street 1:40 AIRPORT RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4524
Mailing Address - Country:US
Mailing Address - Phone:207-680-2070
Mailing Address - Fax:207-680-2074
Practice Address - Street 1:40 AIRPORT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4524
Practice Address - Country:US
Practice Address - Phone:207-680-2070
Practice Address - Fax:207-680-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME197070000Medicaid
ME197070000Medicaid