Basic Information
| Provider Information | |||||||||
| NPI: | 1679776678 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OFFICE OF INTERNAL MEDICINE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1000 DEPT 941 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017260843 | ||||||||
| FaxNumber: | 9012782695 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 EASTMORELAND AVE | ||||||||
| Address2: | STE 550 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381047507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017260843 | ||||||||
| FaxNumber: | 9012782695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 06/06/2016 | ||||||||
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| AuthorizedOfficialLastName: | HABASHY | ||||||||
| AuthorizedOfficialFirstName: | HANY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9017260843 | ||||||||
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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 | MD0000026072 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.