Provider Demographics
NPI: | 1487126272 |
---|---|
Name: | IAC ASSOCIATES PLLC |
Entity type: | Organization |
Organization Name: | IAC ASSOCIATES PLLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | VP, RCM AND PAYOR RELATIONS |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MELISSA |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | BAILEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 972-935-1409 |
Mailing Address - Street 1: | 6101 W PLANO PKWY STE 230 |
Mailing Address - Street 2: | |
Mailing Address - City: | PLANO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75093-8373 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 940-360-4245 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6401 POPLAR AVE STE 500 |
Practice Address - Street 2: | |
Practice Address - City: | MEMPHIS |
Practice Address - State: | TN |
Practice Address - Zip Code: | 38119-4808 |
Practice Address - Country: | US |
Practice Address - Phone: | 901-746-9438 |
Practice Address - Fax: | 941-746-9331 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-12-18 |
Last Update Date: | 2025-04-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 207QA0401X | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | Group - Multi-Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MS | 03401509 | Medicaid | |
TN | Q048108 | Medicaid |