NPIMap

Organization Active NPI

Medical Home Alliance LLC

Doing business as IMA Medical Group - Lake Wales

  • Internal Medicine Physician
  • Lake Wales, FL
National Provider Identifier
1417622853
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MEDICAL HOME ALLIANCE LLC
Doing business as
IMA Medical Group - Lake Wales
Practice address
684 State Road 60 W
Lake Wales, FL 33853-4419
Phone
(863) 949-4868
Fax
(863) 223-8549
NPI assigned
Aug 9, 2021
Last updated
Aug 9, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDICAL HOME ALLIANCE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 9, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vanessa Hourihan
Title
VP of Revenue Cycle
Phone
(407) 845-0322

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

684 State Road 60 W
Lake Wales, FL 33853-4419

Mailing address

6675 Westwood Blvd Ste 475
Orlando, FL 32821-6027
Phone (407) 845-0330

Other names 1

  • IMA Medical Group - Lake Wales Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medical Home Alliance LLC37 organizations share this tax ID, including this one
Part of
Medical Home Alliance LLC

Other organizations with this tax ID 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628467200000",
    "number": "1417622853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6675 WESTWOOD BLVD STE 475",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328216027",
            "telephone_number": "407-845-0330",
            "fax_number": "888-972-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "684 STATE ROAD 60 W",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534419",
            "telephone_number": "863-949-4868",
            "fax_number": "863-223-8549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL HOME ALLIANCE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL HOME ALLIANCE LLC",
        "enumeration_date": "2021-08-09",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A",
        "authorized_official_last_name": "HOURIHAN",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_title_or_position": "VP OF REVENUE CYCLE",
        "authorized_official_telephone_number": "407-845-0322"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMA Medical Group - Lake Wales",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Wales, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.