Provider Demographics
NPI:1982620431
Name:IMC-OBSTETRICS & GYNECOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:IMC-OBSTETRICS & GYNECOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:N
Authorized Official - Last Name:CATRANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-435-7800
Mailing Address - Street 1:3 MOBILE INFIRMARY CIR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3520
Mailing Address - Country:US
Mailing Address - Phone:251-435-7800
Mailing Address - Fax:251-435-7801
Practice Address - Street 1:3 MOBILE INFIRMARY CIR
Practice Address - Street 2:SUITE 401
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3520
Practice Address - Country:US
Practice Address - Phone:251-435-7800
Practice Address - Fax:251-435-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18345207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051526547Medicaid
AL1942201223OtherNPI
ALF83636Medicare UPIN
AL051526547Medicaid