Provider Demographics
NPI:1366787475
Name:INTERNAL MEDICINE CARDIOLOGY MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:INTERNAL MEDICINE CARDIOLOGY MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HYGIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-436-1444
Mailing Address - Street 1:6335 N FRESNO ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5272
Mailing Address - Country:US
Mailing Address - Phone:559-436-1444
Mailing Address - Fax:559-436-4395
Practice Address - Street 1:6335 N FRESNO ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5272
Practice Address - Country:US
Practice Address - Phone:559-436-1444
Practice Address - Fax:559-436-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A387100Medicaid
CA00A387100Medicaid