Provider Demographics
NPI:1891866760
Name:MITCHELL INTERNAL MEDICINE CLINIC
Entity Type:Organization
Organization Name:MITCHELL INTERNAL MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:LYMAN
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:256-718-6858
Mailing Address - Street 1:2115 CLOYD BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-7512
Mailing Address - Country:US
Mailing Address - Phone:256-718-6858
Mailing Address - Fax:256-718-6058
Practice Address - Street 1:2115 CLOYD BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-7512
Practice Address - Country:US
Practice Address - Phone:256-718-6858
Practice Address - Fax:256-718-6058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00009988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51040653OtherBLUE CROSS
AL51040653OtherBLUE CROSS