Provider Demographics
NPI:1902387285
Name:INTEGRATIVE HEALTH SOLUTIONS PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:SUHY
Authorized Official - Last Name:STILLER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:208-920-0285
Mailing Address - Street 1:902 SHEPHERDS LN
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-9707
Mailing Address - Country:US
Mailing Address - Phone:208-920-0285
Mailing Address - Fax:
Practice Address - Street 1:1215 MICHIGAN ST STE B
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-5014
Practice Address - Country:US
Practice Address - Phone:208-920-0285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID54178261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care