Provider Demographics
NPI:1578646493
Name:INTER NAL MEDICINE CLINIC,LLC
Entity type:Organization
Organization Name:INTER NAL MEDICINE CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:AQUADRO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:256-767-5940
Mailing Address - Street 1:204 ANA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1750
Mailing Address - Country:US
Mailing Address - Phone:256-767-5940
Mailing Address - Fax:256-767-5943
Practice Address - Street 1:204 ANA DR
Practice Address - Street 2:SUITE B
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1750
Practice Address - Country:US
Practice Address - Phone:256-767-5940
Practice Address - Fax:256-767-5943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC73688OtherMARTIN
ALC73008Medicare UPIN
ALA99693Medicare UPIN