Basic Information
| Provider Information | |||||||||
| NPI: | 1285688952 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERNAL MEDICINE ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 907 | ||||||||
| Address2: | |||||||||
| City: | EMPORIA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 668010907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203422521 | ||||||||
| FaxNumber: | 6203426520 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 W 12TH AVE | ||||||||
| Address2: | STE 202 | ||||||||
| City: | EMPORIA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 668010907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203422521 | ||||||||
| FaxNumber: | 6203426520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 04/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | GEITZ | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | MELVIN | ||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENT AGENT OF LLC | ||||||||
| AuthorizedOfficialTelephone: | 6203422521 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100303290A | 05 | KS | MEDICAID |