Basic Information
| Provider Information | |||||||||
| NPI: | 1649327792 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OSTEOPATHIC INTERNAL MEDICINE ASSOCIATES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 LECOM PL | ||||||||
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| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165052571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148682535 | ||||||||
| FaxNumber: | 8148682522 | ||||||||
| Practice Location | |||||||||
| Address1: | 2010 W. 38TH ST. | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148685481 | ||||||||
| FaxNumber: | 8148647608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 09/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | STEINBECK | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8148682535 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | OS003106L | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0007339400002 | 01 | PA | MA | OTHER |