Provider Demographics
NPI:1013934892
Name:INTERNAL MEDICINE CLINIC INC.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE CLINIC INC.
Other - Org Name:PHYSICIANS MANAGEMENT CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ABBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS MD
Authorized Official - Phone:970-224-9508
Mailing Address - Street 1:1100 POUDRE RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3500
Mailing Address - Country:US
Mailing Address - Phone:970-224-9508
Mailing Address - Fax:
Practice Address - Street 1:1100 POUDRE RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3500
Practice Address - Country:US
Practice Address - Phone:970-224-9508
Practice Address - Fax:970-224-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC67633Medicare PIN