Provider Demographics
NPI:1790937654
Name:INTERNAL MEDICINE ASSOCIATES OF WEST COUNTY P C
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF WEST COUNTY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TINNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-994-9338
Mailing Address - Street 1:522 N NEW BALLAS RD
Mailing Address - Street 2:STE. 371
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6857
Mailing Address - Country:US
Mailing Address - Phone:314-994-9338
Mailing Address - Fax:314-432-4802
Practice Address - Street 1:522 N NEW BALLAS RD
Practice Address - Street 2:STE. 371
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6857
Practice Address - Country:US
Practice Address - Phone:314-994-9338
Practice Address - Fax:314-432-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty