Provider Demographics
NPI:1689686107
Name:INTEGRATED HEALTH SERVICES
Entity Type:Organization
Organization Name:INTEGRATED HEALTH SERVICES
Other - Org Name:FOREMOST CLINICAL PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-408-1173
Mailing Address - Street 1:5584 N PARAMOUNT BLVD
Mailing Address - Street 2:101
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-5133
Mailing Address - Country:US
Mailing Address - Phone:562-408-1173
Mailing Address - Fax:562-408-3075
Practice Address - Street 1:5584 N PARAMOUNT BLVD
Practice Address - Street 2:101
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-5133
Practice Address - Country:US
Practice Address - Phone:562-408-1173
Practice Address - Fax:562-408-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY46298251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA462980Medicaid
CAZZZ45652ZOtherBLUE SHIELD OF CA. PROV #
CA003739OtherBLUE CROSS CA PROV #
0655870001Medicare NSC