Provider Demographics
NPI:1063062354
Name:INDEPENDENT PHYSICAL MEDICINE LLC
Entity type:Organization
Organization Name:INDEPENDENT PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOMMER
Authorized Official - Middle Name:
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-356-7407
Mailing Address - Street 1:3469 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-2226
Mailing Address - Country:US
Mailing Address - Phone:567-940-9334
Mailing Address - Fax:877-813-6315
Practice Address - Street 1:3469 W ELM ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-2226
Practice Address - Country:US
Practice Address - Phone:567-940-9334
Practice Address - Fax:877-813-6315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty