Basic Information
| Provider Information | |||||||||
| NPI: | 1295787505 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERNAL MEDICINE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 MEMORIAL HOSPITAL DR | ||||||||
| Address2: | #200 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366081786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514145900 | ||||||||
| FaxNumber: | 2512811162 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MEMORIAL HOSPITAL DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366081786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514145900 | ||||||||
| FaxNumber: | 2512811162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 01/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | FREEMAN | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2514145900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1639177553 | 01 | AL | NPI | OTHER | 1316945306 | 01 | AL | NPI | OTHER | 1346248358 | 01 | AL | NPI | OTHER | 1578561593 | 01 | AL | NPI | OTHER | 1881630069 | 01 | AL | NPI | OTHER | 1134145956 | 01 | AL | NPI | OTHER | 1477602571 | 01 | AL | NPI | OTHER | 1154337129 | 01 | AL | NPI | OTHER | 1477642890 | 01 | AL | NPI | OTHER | 1598772204 | 01 | AL | NPI | OTHER | 1053318030 | 01 | AL | NPI | OTHER | 1396730925 | 01 | AL | NPI | OTHER | 1811995731 | 01 | AL | NPI | OTHER | 1952309965 | 01 | AL | NPI | OTHER | 1932107943 | 01 | AL | NPI | OTHER | 1962433862 | 01 | AL | NPI | OTHER | 1265430235 | 01 | AL | NPI | OTHER | 1306844394 | 01 | AL | NPI | OTHER | 1487687745 | 01 | AL | NPI | OTHER | 1497947949 | 01 | AL | NPI | OTHER | 1639110224 | 01 | AL | NPI | OTHER |