Provider Demographics
NPI:1417146408
Name:INFORMED CARE SOLUTIONS, INC
Entity Type:Organization
Organization Name:INFORMED CARE SOLUTIONS, INC
Other - Org Name:INFORMED CARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSOLATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-800-4882
Mailing Address - Street 1:PO BOX 6250
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-6250
Mailing Address - Country:US
Mailing Address - Phone:877-800-4882
Mailing Address - Fax:407-786-4011
Practice Address - Street 1:233 12TH ST
Practice Address - Street 2:SUITE 800
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2462
Practice Address - Country:US
Practice Address - Phone:877-800-4882
Practice Address - Fax:407-786-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024342207Q00000X
GARNO60198 NP363LF0000X
GARN088485363LF0000X
GARN150783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF4461OtherRR MEDICARE
GAGRP6673Medicare PIN