Provider Demographics
NPI:1891844585
Name:WACO INTERNAL MEDICINE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:WACO INTERNAL MEDICINE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHIPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-756-7091
Mailing Address - Street 1:2800 LYLE AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-2680
Mailing Address - Country:US
Mailing Address - Phone:254-756-7091
Mailing Address - Fax:254-754-2666
Practice Address - Street 1:2800 LYLE AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-2680
Practice Address - Country:US
Practice Address - Phone:254-756-7091
Practice Address - Fax:254-754-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DT70Medicare ID - Type UnspecifiedGROUP MEDICARE PROV #