Provider Demographics
NPI:1639295918
Name:INTERNAL MEDICINE ASSOCIATES INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALKA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-773-0012
Mailing Address - Street 1:821 NICKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-1739
Mailing Address - Country:US
Mailing Address - Phone:937-773-0012
Mailing Address - Fax:937-773-3712
Practice Address - Street 1:821 NICKLIN AVE
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-1739
Practice Address - Country:US
Practice Address - Phone:937-773-0012
Practice Address - Fax:937-773-3712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0588976Medicaid
OHIN9178201Medicare ID - Type Unspecified