Provider Demographics
NPI:1336234426
Name:INTERNAL MEDICINE ASSOCIATES OF ASHEBORO, P.C.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF ASHEBORO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-633-1937
Mailing Address - Street 1:PO BOX 4577
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-4577
Mailing Address - Country:US
Mailing Address - Phone:336-633-1937
Mailing Address - Fax:336-633-1942
Practice Address - Street 1:350 N COX ST STE 6
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5514
Practice Address - Country:US
Practice Address - Phone:336-633-1937
Practice Address - Fax:336-633-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2342753Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER