Provider Demographics
NPI: | 1518314665 |
---|---|
Name: | WESTERN INTEGRATED MEDICAL SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | WESTERN INTEGRATED MEDICAL SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | CHARLES |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ANDERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 480-315-1141 |
Mailing Address - Street 1: | 10869 N SCOTTSDALE RD |
Mailing Address - Street 2: | SUITE 103-153 |
Mailing Address - City: | SCOTTSDALE |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85254-5280 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-315-1141 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 10609 N HAYDEN RD |
Practice Address - Street 2: | SUITE E 106 |
Practice Address - City: | SCOTTSDALE |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85260-8531 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-315-1141 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-05-18 |
Last Update Date: | 2016-05-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |