Provider Demographics
NPI:1144430596
Name:COMPREHENSIVE INTERNAL MEDICINE PHYSICIANS OF LIMA
Entity type:Organization
Organization Name:COMPREHENSIVE INTERNAL MEDICINE PHYSICIANS OF LIMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-225-5600
Mailing Address - Street 1:830 W HIGH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3973
Mailing Address - Country:US
Mailing Address - Phone:419-225-5600
Mailing Address - Fax:419-225-6899
Practice Address - Street 1:830 W HIGH ST STE 202
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3973
Practice Address - Country:US
Practice Address - Phone:419-225-5600
Practice Address - Fax:419-225-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI03320Medicare UPIN