Provider Demographics
NPI:1942966627
Name:ADVANCED INTEGRATIVE MEDICAL SERVICES
Entity Type:Organization
Organization Name:ADVANCED INTEGRATIVE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOVIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KANNAMPUZHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-492-1960
Mailing Address - Street 1:800 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 N ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2709
Practice Address - Country:US
Practice Address - Phone:812-492-1960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty