Provider Demographics
NPI:1194764555
Name:INTERNAL MEDICINE ASSOCIATION, P.C.
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATION, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-328-3407
Mailing Address - Street 1:425 HOSPITAL DR
Mailing Address - Street 2:STE 6
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705
Mailing Address - Country:US
Mailing Address - Phone:662-243-2008
Mailing Address - Fax:662-243-2017
Practice Address - Street 1:425 HOSPITAL DR
Practice Address - Street 2:STE 6
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705
Practice Address - Country:US
Practice Address - Phone:662-243-2008
Practice Address - Fax:662-243-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014281Medicaid
CC5941OtherRR MCARE GROUP
MSC02139Medicare PIN