Provider Demographics
NPI:1265440705
Name:INTERNAL MEDICINE ASSOCIATES OF COLUMBIA, PA
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF COLUMBIA, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOHANNES
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-256-6828
Mailing Address - Street 1:2719 MIDDLEBURG DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2414
Mailing Address - Country:US
Mailing Address - Phone:803-256-6828
Mailing Address - Fax:803-256-6827
Practice Address - Street 1:2719 MIDDLEBURG DR
Practice Address - Street 2:SUITE 201
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2414
Practice Address - Country:US
Practice Address - Phone:803-256-6828
Practice Address - Fax:803-256-6827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3800Medicaid
SCGP3800Medicaid