Provider Demographics
NPI:1497379069
Name:CITIZENS INTEGRATED MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:CITIZENS INTEGRATED MEDICAL SERVICES LLC
Other - Org Name:CIMSAZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SANG
Authorized Official - Suffix:
Authorized Official - Credentials:AGACNP-C, FNP-C
Authorized Official - Phone:480-992-1455
Mailing Address - Street 1:1530 E WILLIAMS FIELD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1825
Mailing Address - Country:US
Mailing Address - Phone:480-406-1132
Mailing Address - Fax:480-613-2912
Practice Address - Street 1:1530 E WILLIAMS FIELD RD STE 201
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1825
Practice Address - Country:US
Practice Address - Phone:480-406-1132
Practice Address - Fax:480-613-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1457839896Medicaid