Provider Demographics
NPI:1316058555
Name:INTERNAL MEDICINE ASSOCIATES OF SHELBY COUNTY,INC.
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF SHELBY COUNTY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-392-3211
Mailing Address - Street 1:2158 INTELLIPLEX DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8846
Mailing Address - Country:US
Mailing Address - Phone:317-392-3651
Mailing Address - Fax:317-398-0538
Practice Address - Street 1:2158 INTELLIPLEX DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8846
Practice Address - Country:US
Practice Address - Phone:317-392-3651
Practice Address - Fax:317-398-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200207590Medicaid
IN742420Medicare ID - Type Unspecified