Provider Demographics
NPI:1720447048
Name:INTERNAL MEDICINE ASSOCIATES OF TUSCALOOSA, P.C.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF TUSCALOOSA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:205-349-1824
Mailing Address - Street 1:100 RICE MINE RD N STE B
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2375
Mailing Address - Country:US
Mailing Address - Phone:205-349-1824
Mailing Address - Fax:205-469-2227
Practice Address - Street 1:100 RICE MINE RD N STE B
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2375
Practice Address - Country:US
Practice Address - Phone:205-349-1824
Practice Address - Fax:205-469-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-35504363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty