Basic Information
| Provider Information | |||||||||
| NPI: | 1457320103 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERNAL MEDICINE ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 CARSON ST | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724013104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709321198 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 CARSON ST | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724013104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709321198 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 04/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | ZEIGLER | ||||||||
| AuthorizedOfficialFirstName: | TYLER | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8709107751 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MC0382 | AR | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 101762002 | 05 | AR | MEDICAID |