Provider Demographics
NPI:1750154316
Name:INTEGRATED PATIENT SOLUTIONS OF ARKANSAS, P.A.
Entity type:Organization
Organization Name:INTEGRATED PATIENT SOLUTIONS OF ARKANSAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MODARAI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:980-443-4852
Mailing Address - Street 1:1600 STOUT ST STE 2000
Mailing Address - Street 2:ATTN STRIVE HEALTH CREDENTIALING TEAM
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-3113
Mailing Address - Country:US
Mailing Address - Phone:980-443-4852
Mailing Address - Fax:720-617-8430
Practice Address - Street 1:1600 STOUT ST STE 2000
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-3113
Practice Address - Country:US
Practice Address - Phone:980-443-4852
Practice Address - Fax:720-617-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center