Provider Demographics
NPI:1588719991
Name:PITTSBURG INTERNAL MEDICINE, P.A.
Entity type:Organization
Organization Name:PITTSBURG INTERNAL MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-231-1650
Mailing Address - Street 1:2401 S TUCKER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6619
Mailing Address - Country:US
Mailing Address - Phone:620-231-1650
Mailing Address - Fax:620-231-1685
Practice Address - Street 1:2401 S TUCKER AVE STE 1
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6619
Practice Address - Country:US
Practice Address - Phone:620-231-1650
Practice Address - Fax:620-231-1685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
003926Medicare PIN