Provider Demographics
NPI:1023191210
Name:INTEGRATED MEDICAL, INCORPORATED
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-792-0069
Mailing Address - Street 1:8100 S AKRON ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3508
Mailing Address - Country:US
Mailing Address - Phone:303-792-0069
Mailing Address - Fax:303-792-0702
Practice Address - Street 1:8100 S AKRON ST
Practice Address - Street 2:SUITE 320
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3508
Practice Address - Country:US
Practice Address - Phone:303-792-0069
Practice Address - Fax:303-792-0702
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 Licenses
StateLicense IDTaxonomies
CO21-23918-0000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08822439Medicaid
CO08822439Medicaid