Provider Demographics
NPI:1720272123
Name:INTERNAL MEDICINE PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:N
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-453-5686
Mailing Address - Street 1:3900 SOUTHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3689
Mailing Address - Country:US
Mailing Address - Phone:765-453-5686
Mailing Address - Fax:765-455-8730
Practice Address - Street 1:3900 SOUTHLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3689
Practice Address - Country:US
Practice Address - Phone:765-453-5686
Practice Address - Fax:765-455-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING12532Medicare UPIN
ING38212Medicare UPIN
ING51952Medicare UPIN