Provider Demographics
NPI:1336563543
Name:ADVANCED INTERNAL MEDICINE PLLC
Entity type:Organization
Organization Name:ADVANCED INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:FRAZINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-994-2625
Mailing Address - Street 1:2005 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7107
Mailing Address - Country:US
Mailing Address - Phone:270-366-7650
Mailing Address - Fax:270-443-0600
Practice Address - Street 1:2005 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7107
Practice Address - Country:US
Practice Address - Phone:270-366-7650
Practice Address - Fax:270-443-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK131030Medicare PIN