Provider Demographics
NPI:1891740874
Name:INTERNAL MEDICINE ASSOCIATES, INC.
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF AMBULATORY PRACTICES
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITCHUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-384-6840
Mailing Address - Street 1:4428 INDIAN RIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3264
Mailing Address - Country:US
Mailing Address - Phone:937-431-4140
Mailing Address - Fax:
Practice Address - Street 1:4428 INDIAN RIPPLE RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3264
Practice Address - Country:US
Practice Address - Phone:937-431-4140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0707882Medicaid
OH=========OtherTAX ID
OH0707882Medicaid