Provider Demographics
NPI:1326159401
Name:INTEGRATED HEALTH SERVICES MANAGEMENT INC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH SERVICES MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANSOOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-239-7533
Mailing Address - Street 1:17900 JEFFERSON PARK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3437
Mailing Address - Country:US
Mailing Address - Phone:440-274-5035
Mailing Address - Fax:440-260-6153
Practice Address - Street 1:21625 CHAGRIN BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5363
Practice Address - Country:US
Practice Address - Phone:216-283-2123
Practice Address - Fax:216-283-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-064007207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000121632OtherANTHEM
OH4316806OtherAETNA
OH69713OtherQUALCHOICE
OH=========OtherTRICARE
OH4316806OtherAETNA
OH69713OtherQUALCHOICE