Provider Demographics
NPI:1720106859
Name:INTERNAL MEDICINE ASSOCIATES OF MONTGOMERY PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF MONTGOMERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-279-9211
Mailing Address - Street 1:6940 WINTON BLOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3556
Mailing Address - Country:US
Mailing Address - Phone:334-279-9211
Mailing Address - Fax:334-279-9925
Practice Address - Street 1:6940 WINTON BLOUNT BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3556
Practice Address - Country:US
Practice Address - Phone:334-279-9211
Practice Address - Fax:334-279-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCK4854OtherRAILROAD MEDICARE
AL528600110Medicaid
ALCK4854OtherRAILROAD MEDICARE