Provider Demographics
NPI:1346789872
Name:INTEGRATED MEDICAL SERVICES
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-656-3481
Mailing Address - Street 1:PO BOX 910855
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-0855
Mailing Address - Country:US
Mailing Address - Phone:435-656-3481
Mailing Address - Fax:
Practice Address - Street 1:630 S 400 E
Practice Address - Street 2:101
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3765
Practice Address - Country:US
Practice Address - Phone:435-656-3481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTPENDINGMedicare UPIN