Provider Demographics
NPI:1942300827
Name:INTERNAL MEDICINE PHYSICIANS, INC
Entity type:Organization
Organization Name:INTERNAL MEDICINE PHYSICIANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GUTTI
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-283-9993
Mailing Address - Street 1:515 SIMPSON DR
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MS
Mailing Address - Zip Code:38967-3009
Mailing Address - Country:US
Mailing Address - Phone:662-283-9993
Mailing Address - Fax:662-283-4088
Practice Address - Street 1:515 SIMPSON DR
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-3009
Practice Address - Country:US
Practice Address - Phone:662-283-9993
Practice Address - Fax:662-283-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01686771Medicaid
MS110001269Medicare PIN
MSH08504Medicare UPIN
MSG64749Medicare UPIN
MS01686771Medicaid
MS110001270Medicare PIN