Provider Demographics
NPI:1992972087
Name:INTERNAL MEDICINE ASSOCIATES OF SOUTHERN HILLS LLC
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF SOUTHERN HILLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-5135
Mailing Address - Street 1:393 WALLACE RD
Mailing Address - Street 2:SUITE 104-A
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4880
Mailing Address - Country:US
Mailing Address - Phone:615-331-4104
Mailing Address - Fax:615-331-9962
Practice Address - Street 1:393 WALLACE RD
Practice Address - Street 2:SUITE 104-A
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4880
Practice Address - Country:US
Practice Address - Phone:615-331-4104
Practice Address - Fax:615-331-9962
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL CORP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-08
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506012Medicaid
TN3370308Medicare PIN