Provider Demographics
NPI:1750636650
Name:INTEGRATED MEDICAL CONSULTANTS
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL CONSULTANTS
Other - Org Name:COLORADO CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FEEBACK
Authorized Official - Suffix:
Authorized Official - Credentials:PRACTICE ADMINISTRAT
Authorized Official - Phone:970-221-9451
Mailing Address - Street 1:PO BOX 574
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-0574
Mailing Address - Country:US
Mailing Address - Phone:970-221-9451
Mailing Address - Fax:877-535-9359
Practice Address - Street 1:3810 N. GRANT AVE.
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8412
Practice Address - Country:US
Practice Address - Phone:970-221-9451
Practice Address - Fax:877-535-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35700207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA106913Medicare UPIN