Provider Demographics
NPI:1922311265
Name:VIRGINIA INPATIENT MEDICINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:VIRGINIA INPATIENT MEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CHIEF OPERATING OFFICIER
Authorized Official - Prefix:DR
Authorized Official - First Name:TALBOT
Authorized Official - Middle Name:GREEN
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:678-441-8500
Mailing Address - Street 1:PO BOX 96368
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-6368
Mailing Address - Country:US
Mailing Address - Phone:678-441-8500
Mailing Address - Fax:678-397-0065
Practice Address - Street 1:5901 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE C-350
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5382
Practice Address - Country:US
Practice Address - Phone:678-441-8500
Practice Address - Fax:678-397-0065
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE HOSPITAL PHYSICIANS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-15
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5922470Medicaid
VADR2432OtherRR MEDICARE
NC5922470Medicaid