Provider Demographics
NPI:1871638312
Name:INDEPENDENT MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:INDEPENDENT MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOMINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-253-3489
Mailing Address - Street 1:1007 S OAKWOOD AVE
Mailing Address - Street 2:SUITE 950
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5935
Mailing Address - Country:US
Mailing Address - Phone:304-253-3489
Mailing Address - Fax:304-253-3148
Practice Address - Street 1:1007 S OAKWOOD AVE
Practice Address - Street 2:SUITE 950
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5935
Practice Address - Country:US
Practice Address - Phone:304-253-3489
Practice Address - Fax:304-253-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVW43609Medicare UPIN
WVK00774811Medicare ID - Type Unspecified