Provider Demographics
NPI:1780020156
Name:INTEGRATED SURGICAL INC
Entity Type:Organization
Organization Name:INTEGRATED SURGICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLERREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-783-0864
Mailing Address - Street 1:5222 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-4838
Mailing Address - Country:US
Mailing Address - Phone:904-783-0864
Mailing Address - Fax:904-783-0508
Practice Address - Street 1:5222 LENOX AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4838
Practice Address - Country:US
Practice Address - Phone:904-783-0864
Practice Address - Fax:904-783-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty