Provider Demographics
NPI:1891431250
Name:INTEGRATED MEDICAL SPECIALISTS PLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL SPECIALISTS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHASTANT
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:480-993-9199
Mailing Address - Street 1:1812 N HORNET WAY
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7703
Mailing Address - Country:US
Mailing Address - Phone:480-993-9199
Mailing Address - Fax:
Practice Address - Street 1:930 N SWITZER CANYON DR STE 104
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4834
Practice Address - Country:US
Practice Address - Phone:928-499-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care