Provider Demographics
NPI:1467511782
Name:ASSOCIATED INTERNISTS PC
Entity type:Organization
Organization Name:ASSOCIATED INTERNISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-574-6141
Mailing Address - Street 1:804 KENYON RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5742
Mailing Address - Country:US
Mailing Address - Phone:515-574-6141
Mailing Address - Fax:515-574-6145
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:SUITE D
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5742
Practice Address - Country:US
Practice Address - Phone:515-574-6141
Practice Address - Fax:515-574-6145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0173674Medicaid
IA17367OtherBLUE CROSS BLUE SHIELD
IACP7467OtherRR MEDICARE
IACP7467OtherRR MEDICARE