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?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty