Provider Demographics
NPI:1982876587
Name:INTERNAL MEDICINE & GERIATRIC SPECIALISTS, INC.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE & GERIATRIC SPECIALISTS, INC.
Other - Org Name:FAMILY MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:QUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-264-4433
Mailing Address - Street 1:1004 TAVERN RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2864
Mailing Address - Country:US
Mailing Address - Phone:304-264-4433
Mailing Address - Fax:304-264-4446
Practice Address - Street 1:1004 TAVERN RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2864
Practice Address - Country:US
Practice Address - Phone:304-264-4433
Practice Address - Fax:304-264-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23821207Q00000X
WV20638207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810011501Medicaid
WVIN9375901Medicare PIN