Provider Demographics
NPI:1154361988
Name:INTERNAL MEDICINE ASSOCIATES, P.A.
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHITTICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-263-6876
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0550
Mailing Address - Country:US
Mailing Address - Phone:208-263-6876
Mailing Address - Fax:208-263-2033
Practice Address - Street 1:102 S EUCLID AVE STE 202
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-4912
Practice Address - Country:US
Practice Address - Phone:208-263-6876
Practice Address - Fax:208-263-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7081557Medicaid
ID000010006479OtherBS GROUP NUMBER
MT0351312Medicaid
ID805074900Medicaid
ID87841OtherBC GROUP NUMBER
MT0351312Medicaid
WA7081557Medicaid