1306237300 NPI number — INTEGRATIVE PHYSICIAN SERVICES INC.

Table of content: (NPI 1306237300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306237300 NPI number — INTEGRATIVE PHYSICIAN SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATIVE PHYSICIAN SERVICES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306237300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
138 PALM COAST PKWY NE
Provider Second Line Business Mailing Address:
SUITE 127
Provider Business Mailing Address City Name:
PALM COAST
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32137-8241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-362-4183
Provider Business Mailing Address Fax Number:
386-456-3071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4490 N US HIGHWAY 1
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
BUNNELL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32110-4374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-362-4183
Provider Business Practice Location Address Fax Number:
386-456-3071
Provider Enumeration Date:
02/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
800-362-4183

Provider Taxonomy Codes

  • Taxonomy code: 111NI0013X , with the licence number:  CH11373 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com