Provider Demographics
NPI:1487837456
Name:INTEGRATED MEDICAL INCORPORATED
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SOMERVILLE
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:405-755-8000
Mailing Address - Street 1:PO BOX 57079
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-7079
Mailing Address - Country:US
Mailing Address - Phone:405-755-8000
Mailing Address - Fax:405-755-8001
Practice Address - Street 1:9402 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2701
Practice Address - Country:US
Practice Address - Phone:405-755-8000
Practice Address - Fax:405-755-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10060204D00000X
207LP2900X, 207Q00000X, 208100000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty