Provider Demographics
NPI:1427374206
Name:INTEGRATED MEDICAL INC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAJUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-332-1550
Mailing Address - Street 1:15627 NEO PKWY
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-3150
Mailing Address - Country:US
Mailing Address - Phone:216-332-1550
Mailing Address - Fax:216-332-1555
Practice Address - Street 1:2047 LOCUST ST S
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-9337
Practice Address - Country:US
Practice Address - Phone:330-408-7380
Practice Address - Fax:330-408-7384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH76150538332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3054608Medicaid
OH1250140004Medicare NSC