Provider Demographics
NPI:1164432241
Name:INTEGRATED MEDICAL CONSULTANTS
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL CONSULTANTS
Other - Org Name:COLORADO PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FEEBACK, MBA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:970-221-9451
Mailing Address - Street 1:PO BOX 271160
Mailing Address - Street 2:
Mailing Address - City:FT. COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527
Mailing Address - Country:US
Mailing Address - Phone:970-221-9451
Mailing Address - Fax:877-535-9359
Practice Address - Street 1:3810 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538
Practice Address - Country:US
Practice Address - Phone:970-221-9451
Practice Address - Fax:877-535-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO448838Medicare ID - Type UnspecifiedMEDICARE NUMBER