Provider Demographics
NPI:1407041296
Name:LA GRANGE INTERNAL MEDICINE
Entity type:Organization
Organization Name:LA GRANGE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:PIERATT
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:979-242-2324
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-0340
Mailing Address - Country:US
Mailing Address - Phone:979-242-2324
Mailing Address - Fax:979-242-5127
Practice Address - Street 1:1 SAINT MARKS PL
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1250
Practice Address - Country:US
Practice Address - Phone:979-242-2324
Practice Address - Fax:979-242-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00444ZMedicare PIN