| Internal Medicine Associates Inc | |
|
4450 31st Ave S Ste 102 Fargo ND 58104-4557 | |
| (701) 280-2033 | |
| (701) 232-5578 |
| Full Name | Internal Medicine Associates Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4450 31st Ave S Ste 102, Fargo, North Dakota |
| Authorized Official Name and Position | Michael J Lillestol (PRESIDENT) |
| Authorized Official Contact | 7012802033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Medicine Associates Inc 4450 31st Ave S Ste 102 Fargo ND 58104-4557 Ph: (701) 280-2033 | Internal Medicine Associates Inc 4450 31st Ave S Ste 102 Fargo ND 58104-4557 Ph: (701) 280-2033 |
| NPI Number | 1144313743 |
|---|---|
| Provider Enumeration Date | 10/02/2006 |
| Last Update Date | 03/23/2020 |
| Medicare PECOS PAC ID | 8527027879 |
|---|---|
| Medicare Enrollment ID | O20041004000768 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144313743 | NPI | - | NPPES |
| 162D7IN | Other | MN | MN BLUE SHIELD |
| 301713300 | Medicaid | MN | |
| 11941 | Medicaid | ND | |
| 05595001 | Other | ND | ND BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jenifer E Jones |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1588698088 PECOS PAC ID: 7810976289 Enrollment ID: I20040719000703 |
| Provider Name | Steven Glenn Clemenson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174541874 PECOS PAC ID: 2860301249 Enrollment ID: I20040908000176 |
| Provider Name | Brent M Hella |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245286988 PECOS PAC ID: 8820057177 Enrollment ID: I20041004000687 |
| Provider Name | Bhanu Odedra Mistry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194742668 PECOS PAC ID: 6406811074 Enrollment ID: I20041123000245 |
| Provider Name | Denise M Schumacher |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1124049341 PECOS PAC ID: 5496777898 Enrollment ID: I20051229000167 |
| Provider Name | Timothy J Mahoney |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1689608192 PECOS PAC ID: 0840195822 Enrollment ID: I20071205000061 |
| Provider Name | Mark G Yohe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346403995 PECOS PAC ID: 1052486826 Enrollment ID: I20080814000077 |
| Provider Name | Michael John Lillestol |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669427688 PECOS PAC ID: 3577662634 Enrollment ID: I20101022000179 |
| Provider Name | Pamela P Holtz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982973251 PECOS PAC ID: 3072771914 Enrollment ID: I20120222001007 |
| Provider Name | Jessica R Kuhn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245591502 PECOS PAC ID: 0749431898 Enrollment ID: I20121119000279 |
| Provider Name | Michael J Blankinship |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1780826867 PECOS PAC ID: 4789827635 Enrollment ID: I20130826000514 |
| Provider Name | Ronovan Lavaine Ottenbacher |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548516032 PECOS PAC ID: 9537473038 Enrollment ID: I20150728005050 |
| Provider Name | Mykell M Barnacle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790921252 PECOS PAC ID: 7911204193 Enrollment ID: I20160404000516 |
| Provider Name | Tracey Dillon |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1295288926 PECOS PAC ID: 7012203037 Enrollment ID: I20170403002241 |
| Provider Name | Karissa M Emerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912490830 PECOS PAC ID: 9830449024 Enrollment ID: I20180910001706 |
| Provider Name | Amanda Nack |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1770058232 PECOS PAC ID: 6002151636 Enrollment ID: I20181231001178 |
| Provider Name | Tracy K Fiser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154711943 PECOS PAC ID: 6406172014 Enrollment ID: I20200529001363 |
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