Provider Demographics
NPI:1447312665
Name:INTERNAL MEDICINE GROUP
Entity type:Organization
Organization Name:INTERNAL MEDICINE GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAGUSIVAKUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMESHBABU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-366-3900
Mailing Address - Street 1:225 S HERLONG AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732
Mailing Address - Country:US
Mailing Address - Phone:803-366-3900
Mailing Address - Fax:803-366-1213
Practice Address - Street 1:834 W. MEETING ST.
Practice Address - Street 2:SUITE F
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720
Practice Address - Country:US
Practice Address - Phone:803-285-8777
Practice Address - Fax:803-285-8776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23616207R00000X
SC23688207R00000X
SC30340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4455Medicaid
SCGP3868Medicaid
SC7882Medicare ID - Type UnspecifiedGROUP NUMBER
SCH76390Medicare UPIN
SCAA2704Medicare UPIN
SCH77155Medicare UPIN