Basic Information
| Provider Information | |||||||||
| NPI: | 1811981038 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTERNAL MEDICINE ASSOCIATES OF OCALA PA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1623 SW 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344716528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527329844 | ||||||||
| FaxNumber: | 3527326787 | ||||||||
| Practice Location | |||||||||
| Address1: | 1623 SW 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344716528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527329844 | ||||||||
| FaxNumber: | 3527326787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2005 | ||||||||
| LastUpdateDate: | 03/06/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | REDDY | ||||||||
| AuthorizedOfficialFirstName: | KUCHAKULLA | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3527329844 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2735105 00 | 05 | FL | MEDICAID | 94988 | 01 | FL | BCBS OF FL | OTHER | 610335900 | 01 | FL | FEDERAL BLACK LUNG | OTHER | DD7923 | 01 | FL | MEDICARE RAILROAD | OTHER |