Provider Demographics
NPI:1992846901
Name:INTEGRATED CONCEPTS, INC.
Entity Type:Organization
Organization Name:INTEGRATED CONCEPTS, INC.
Other - Org Name:PHARMACARE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNTINGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-345-9299
Mailing Address - Street 1:915 FARMINGTON AVE
Mailing Address - Street 2:SUITE E-1
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-7475
Mailing Address - Country:US
Mailing Address - Phone:505-564-9933
Mailing Address - Fax:505-564-9955
Practice Address - Street 1:915 FARMINGTON AVE
Practice Address - Street 2:SUITE E-1
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-7475
Practice Address - Country:US
Practice Address - Phone:505-564-9933
Practice Address - Fax:505-564-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM07-00004231332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1053314237OtherNPI NUMBER FOR CORPORATE
NML7182Medicaid
NML7182Medicaid