Provider Demographics
NPI:1861824567
Name:INTERNAL MEDICINE ASSOCIATES OF SOUTH TEXAS PLLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF SOUTH TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-597-0195
Mailing Address - Street 1:6909 VISTA RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4553
Mailing Address - Country:US
Mailing Address - Phone:214-597-0195
Mailing Address - Fax:
Practice Address - Street 1:7800 OAKMONT BLVD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4203
Practice Address - Country:US
Practice Address - Phone:917-680-9728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3283174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5437Medicare PIN