Provider Demographics
NPI:1659818847
Name:INTEGRATED IMMUNOLOGY SOLUTIONS LLC
Entity Type:Organization
Organization Name:INTEGRATED IMMUNOLOGY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-607-4333
Mailing Address - Street 1:1810 E MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-1237
Mailing Address - Country:US
Mailing Address - Phone:405-607-4333
Mailing Address - Fax:405-607-4404
Practice Address - Street 1:1810 E MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73131-1237
Practice Address - Country:US
Practice Address - Phone:405-607-4333
Practice Address - Fax:405-607-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty