Provider Demographics
NPI:1881002996
Name:IMA MEDICAL HOME TEAM LLC
Entity Type:Organization
Organization Name:IMA MEDICAL HOME TEAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-234-0332
Mailing Address - Street 1:1515 HERITAGE DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3379
Mailing Address - Country:US
Mailing Address - Phone:855-860-2109
Mailing Address - Fax:
Practice Address - Street 1:551 AZALEA DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-7900
Practice Address - Country:US
Practice Address - Phone:662-234-0332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07454207R00000X
MS13540207R00000X
MS13892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty