Provider Demographics
NPI:1730370164
Name:INTERNAL MEDICINE ASSOCIATES OF COLUMBUS, P.C.
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF COLUMBUS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-243-2013
Mailing Address - Street 1:425 HOSPITAL DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1901
Mailing Address - Country:US
Mailing Address - Phone:662-243-2013
Mailing Address - Fax:
Practice Address - Street 1:425 HOSPITAL DR
Practice Address - Street 2:SUITE 6
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1901
Practice Address - Country:US
Practice Address - Phone:662-243-2013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERNAL MEDICINE ASSOCIATES OF COLUMBUS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-09
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116356Medicaid