Provider Demographics
NPI:1356806517
Name:INTEGRATED MOBILE MEDICAL SUNCREST ADVANCED ILLNESS MANAGEMENT
Entity type:Organization
Organization Name:INTEGRATED MOBILE MEDICAL SUNCREST ADVANCED ILLNESS MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GINIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BURDICK
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-C
Authorized Official - Phone:719-247-1600
Mailing Address - Street 1:206 N 2100 W STE 202
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-4741
Mailing Address - Country:US
Mailing Address - Phone:801-924-8571
Mailing Address - Fax:801-883-8044
Practice Address - Street 1:5700 S QUEBEC ST STE 310
Practice Address - Street 2:
Practice Address - City:GREENWOOD VLG
Practice Address - State:CO
Practice Address - Zip Code:80111-2008
Practice Address - Country:US
Practice Address - Phone:719-247-1600
Practice Address - Fax:801-883-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty