Provider Demographics
NPI:1255330403
Name:INTEGRATED CARE SYSTEMS INC
Entity Type:Organization
Organization Name:INTEGRATED CARE SYSTEMS INC
Other - Org Name:INTEGRATED CARE SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KOMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-734-2896
Mailing Address - Street 1:7140 W. PERSHING CT.
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291
Mailing Address - Country:US
Mailing Address - Phone:559-734-2896
Mailing Address - Fax:559-734-6451
Practice Address - Street 1:7140 W. PERSHING CT.
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291
Practice Address - Country:US
Practice Address - Phone:559-734-2896
Practice Address - Fax:559-734-6451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY47381251F00000X, 3336H0001X, 3336S0011X
CAPHY45751332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No251F00000XAgenciesHome Infusion
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255330403Medicaid
CAPHA457510Medicaid
CA0521496OtherNABP NUMBER
CAPHY47381OtherPHARMACY PERMIT
CA5857680001Medicare NSC