Provider Demographics
NPI:1518402650
Name:INTEGRATED MEDICAL SERVICES
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE SUPERVISOR/MA
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:928-472-4675
Mailing Address - Street 1:111 W CEDAR LANE
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541
Mailing Address - Country:US
Mailing Address - Phone:928-472-4675
Mailing Address - Fax:928-472-3431
Practice Address - Street 1:111 W CEDAR LN
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5417
Practice Address - Country:US
Practice Address - Phone:928-472-4675
Practice Address - Fax:928-472-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization