Provider Demographics
NPI:1023183043
Name:INTEGRATED PROFESSIONAL SERV LLC
Entity Type:Organization
Organization Name:INTEGRATED PROFESSIONAL SERV LLC
Other - Org Name:UTAH SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:IKHTIARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:NABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-747-0921
Mailing Address - Street 1:PO BOX 651004
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84165-1004
Mailing Address - Country:US
Mailing Address - Phone:801-747-0921
Mailing Address - Fax:801-747-0986
Practice Address - Street 1:515 E 4500 S
Practice Address - Street 2:SUITE G-220
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-4500
Practice Address - Country:US
Practice Address - Phone:801-747-0921
Practice Address - Fax:801-747-0986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT44633261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT470001928OtherRR MEDICARE
UT606218700OtherACS US DEPT. OF LABOR
UTQM0000061972OtherALTIUS HEALTH PLANS
UT51803040100001OtherBLUE CROSS BLUE SHIELD
UT72595OtherPEHP
UT=========001Medicaid
UT470001928OtherRR MEDICARE
UTQM0000061972OtherALTIUS HEALTH PLANS
UTX76629Medicare UPIN
UT000090741Medicare ID - Type UnspecifiedIND. DIAG. TESTING FAC.