1083637946 NPI number — ASSOCIATES IN INTERNAL MEDICINE, INC.

Table of content: (NPI 1083637946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083637946 NPI number — ASSOCIATES IN INTERNAL MEDICINE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATES IN INTERNAL MEDICINE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083637946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
254 STRATTON RD
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
RUTLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05701-4675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-775-5531
Provider Business Mailing Address Fax Number:
802-773-4697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
254 STRATTON RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
RUTLAND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05701-4675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-775-5531
Provider Business Practice Location Address Fax Number:
802-773-4697
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEAVER
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
802-775-5531

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  042-0004441 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 042-0004441 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4373 . This is a "BCBS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0004373 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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