| Entity Name: | INTERNAL MEDICINE ASSOCIATES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 05 Aug 1987 (37 years ago) |
| Document Number: | J85658 |
| FEI/EIN Number | 592835793 |
| Address: | 126 J.F.K. CIRCLE, ATLANTIS, FL, 33462 |
| Mail Address: | 126 J.F.K. CIRCLE, ATLANTIS, FL, 33462 |
| ZIP code: | 33462 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417974999 | 2006-07-17 | 2013-12-17 | 4250 HOSPITAL DR, MARIANNA, FL, 324461917, US | 4318 5TH AVE, MARIANNA, FL, 324462182, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-526-5300 |
Authorized person
| Name | MRS. YVONNE HART |
| Role | INSURANCE SPECIALIST |
| Phone | 8505265300 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 660033600 |
| State | FL |
| Issuer | MEDICAID |
| Number | 660033601 |
| State | FL |
| Issuer | RURAL HEALTH CLINIC BCBS |
| Number | W42 |
| State | FL |
| Issuer | BCBS GROUP NUMBER |
| Number | 34202 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CARROLL, DIANNE | Agent | 1000-45TH ST., STE. #2, WEST PALM BEACH, FL, 33407 |
| Name | Role | Address |
|---|---|---|
| CARROLL, DIANNE | President | 1000 45TH ST., W PALM BEACH, FL |
| Name | Role | Address |
|---|---|---|
| CARROLL, DIANNE | Vice President | 1000 45TH ST., W PALM BEACH, FL |
| Name | Role | Address |
|---|---|---|
| CARROLL, DIANNE | Director | 1000 45TH ST., W PALM BEACH, FL |
| Name | Role | Address |
|---|---|---|
| CARROLL, DIANNE | Secretary | 1000 45TH ST., W PALM BEACH, FL |
| Name | Role | Address |
|---|---|---|
| CARROLL, DIANNE | Treasurer | 1000 45TH ST., W PALM BEACH, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1991-10-11 | No data | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
