Provider Demographics
NPI:1336718204
Name:INTEGRATED TMS LLC
Entity Type:Organization
Organization Name:INTEGRATED TMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:JIM
Authorized Official - Last Name:WOLVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-767-8840
Mailing Address - Street 1:1664 S DIXIE DR STE 102
Mailing Address - Street 2:BLD E
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7327
Mailing Address - Country:US
Mailing Address - Phone:435-767-8840
Mailing Address - Fax:435-703-6003
Practice Address - Street 1:1664 S DIXIE DR STE 102
Practice Address - Street 2:BLD E
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7327
Practice Address - Country:US
Practice Address - Phone:435-767-8840
Practice Address - Fax:435-703-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1972846384Medicaid
UT1730125956Medicaid