Provider Demographics
NPI:1659467512
Name:INTERNAL MEDICINE CLINIC, LTD
Entity Type:Organization
Organization Name:INTERNAL MEDICINE CLINIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-364-7551
Mailing Address - Street 1:335 OXFORD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1970
Mailing Address - Country:US
Mailing Address - Phone:330-364-7551
Mailing Address - Fax:330-364-7553
Practice Address - Street 1:335 OXFORD ST STE C
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1970
Practice Address - Country:US
Practice Address - Phone:330-364-7551
Practice Address - Fax:330-364-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH19821Medicare UPIN