Provider Demographics
NPI:1619242575
Name:INTEGRATED MEDICAL SERVICES HAM, LLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL SERVICES HAM, LLC
Other - Org Name:AAMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:504-723-8399
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-0716
Mailing Address - Country:US
Mailing Address - Phone:504-723-8399
Mailing Address - Fax:
Practice Address - Street 1:303 W MINNESOTA PARK RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-6149
Practice Address - Country:US
Practice Address - Phone:985-350-6110
Practice Address - Fax:985-350-6109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA024908208D00000X
LARN102334-AP06140363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty