Provider Demographics
NPI:1659309391
Name:ANDREWS INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:ANDREWS INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-321-4510
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:2751 BUSINESS HWY 19
Mailing Address - City:ANDREWS
Mailing Address - State:NC
Mailing Address - Zip Code:28901-0550
Mailing Address - Country:US
Mailing Address - Phone:828-321-4510
Mailing Address - Fax:828-321-3973
Practice Address - Street 1:2751 BUSINESS HWY 19
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:NC
Practice Address - Zip Code:28901
Practice Address - Country:US
Practice Address - Phone:828-321-4510
Practice Address - Fax:828-321-3973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30895207Q00000X
NC39876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8922869Medicaid
NC8973103Medicaid
NCC11107OtherRAILROAD
NC8912824Medicaid
NCH34653Medicare UPIN
NC8912824Medicaid
NC8922869Medicaid
NC2285030Medicare ID - Type UnspecifiedMEDICARE
NC8973103Medicaid
NCE75937Medicare UPIN