Provider Demographics
NPI:1013937895
Name:ACACIA INTERNAL MEDICINE
Entity Type:Organization
Organization Name:ACACIA INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-869-5000
Mailing Address - Street 1:20040 N 19TH AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4013
Mailing Address - Country:US
Mailing Address - Phone:623-869-5000
Mailing Address - Fax:623-869-0927
Practice Address - Street 1:20040 N 19TH AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:623-869-5000
Practice Address - Fax:623-869-0927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
28169Medicare ID - Type Unspecified
AZ28169Medicare PIN