Provider Demographics
NPI:1962452979
Name:INTERNAL MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-322-0512
Mailing Address - Street 1:507 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7545
Mailing Address - Country:US
Mailing Address - Phone:318-322-0512
Mailing Address - Fax:318-387-6794
Practice Address - Street 1:507 WOOD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7545
Practice Address - Country:US
Practice Address - Phone:318-322-0512
Practice Address - Fax:318-387-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1793507Medicaid
C01091OtherRAILROAD MEDICARE
LA5B280Medicare ID - Type Unspecified