Provider Demographics
NPI:1427056001
Name:INTERNAL MEDICINE RURAL HEALTH CLINIC OF NEW ALBANY PA
Entity type:Organization
Organization Name:INTERNAL MEDICINE RURAL HEALTH CLINIC OF NEW ALBANY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER- VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:BARKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-534-8166
Mailing Address - Street 1:300 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3117
Mailing Address - Country:US
Mailing Address - Phone:662-534-8166
Mailing Address - Fax:662-534-8132
Practice Address - Street 1:300 OXFORD RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3117
Practice Address - Country:US
Practice Address - Phone:662-534-8166
Practice Address - Fax:662-534-8132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA8144OtherRAILROAD MEDICARE
MS09014297Medicaid
DA8144OtherRAILROAD MEDICARE
MS09014297Medicaid