Provider Demographics
NPI:1811094022
Name:INTERNAL MEDICINE ASSOCIATES OF TULLAHOMA PC
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF TULLAHOMA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-455-7767
Mailing Address - Street 1:1805 N JACKSON ST
Mailing Address - Street 2:BLDG A SUITE 100
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388
Mailing Address - Country:US
Mailing Address - Phone:931-455-7767
Mailing Address - Fax:931-455-8636
Practice Address - Street 1:1805 N JACKSON ST
Practice Address - Street 2:BLDG A SUITE 100
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388
Practice Address - Country:US
Practice Address - Phone:931-455-7767
Practice Address - Fax:931-455-8636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4400309810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724077Medicaid
TNCH1576OtherRR MCR
TN4090988OtherBCBS
TN4090988OtherBCBS