Provider Demographics
NPI:1659023299
Name:INTERGRATED MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:INTERGRATED MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-743-4060
Mailing Address - Street 1:1001 BERRYVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-5900
Mailing Address - Country:US
Mailing Address - Phone:703-743-4060
Mailing Address - Fax:
Practice Address - Street 1:101 MEDICAL CT STE 206
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3854
Practice Address - Country:US
Practice Address - Phone:540-779-0607
Practice Address - Fax:540-784-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health