Provider Demographics
NPI:1821039330
Name:INTERMED ASSOCIATES, INC
Entity Type:Organization
Organization Name:INTERMED ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-872-3213
Mailing Address - Street 1:1103 VILLAGE SQUARE DR
Mailing Address - Street 2:SUITE #100
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1783
Mailing Address - Country:US
Mailing Address - Phone:419-872-3213
Mailing Address - Fax:419-872-9549
Practice Address - Street 1:1103 VILLAGE SQUARE DR
Practice Address - Street 2:SUITE #100
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1783
Practice Address - Country:US
Practice Address - Phone:419-872-3213
Practice Address - Fax:419-872-9549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-003664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0611341Medicaid
OH0611341Medicaid