Provider Demographics
NPI:1770618746
Name:INTERNAL MEDICINE GROUP OF CAPE GIRARDEAU, INC.
Entity type:Organization
Organization Name:INTERNAL MEDICINE GROUP OF CAPE GIRARDEAU, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWETTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-334-9641
Mailing Address - Street 1:3250 GORDONVILLE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5056
Mailing Address - Country:US
Mailing Address - Phone:573-334-9641
Mailing Address - Fax:573-331-3120
Practice Address - Street 1:3250 GORDONVILLE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5056
Practice Address - Country:US
Practice Address - Phone:573-334-9641
Practice Address - Fax:573-331-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC50096Medicare PIN
MO0424300001Medicare NSC