Provider Demographics
NPI:1952363632
Name:PENNMARC INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:PENNMARC INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HORMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-525-3086
Mailing Address - Street 1:6401 POPLAR AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4823
Mailing Address - Country:US
Mailing Address - Phone:901-525-3086
Mailing Address - Fax:901-525-0844
Practice Address - Street 1:6401 POPLAR AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4823
Practice Address - Country:US
Practice Address - Phone:901-525-3086
Practice Address - Fax:901-525-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3372922Medicare ID - Type Unspecified