1477701449 NPI number — INTEGRATED MED/PSYCH RESOURCES, P.C.

Table of content: (NPI 1477701449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477701449 NPI number — INTEGRATED MED/PSYCH RESOURCES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED MED/PSYCH RESOURCES, P.C.
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:
1477701449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 413
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIAWATHA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52233-0413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-743-3312
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 10TH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52403-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-398-6022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STUTTS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
310-743-3312

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  03253 , registered in the state of IA ; 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