Provider Demographics
NPI:1922156207
Name:COMMUNITY INTERNISTS & ASSOCIATES PC
Entity Type:Organization
Organization Name:COMMUNITY INTERNISTS & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-453-8668
Mailing Address - Street 1:3505 S REED RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3838
Mailing Address - Country:US
Mailing Address - Phone:765-453-8666
Mailing Address - Fax:765-864-6785
Practice Address - Street 1:3505 S REED RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3838
Practice Address - Country:US
Practice Address - Phone:765-453-8666
Practice Address - Fax:765-864-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200169400Medicaid
IN200169400Medicaid