1629411046 NPI number — IMS URGENT CARE DBA INTERGRATED MEDICAL SERVICES, INC.

Table of content: (NPI 1629411046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629411046 NPI number — IMS URGENT CARE DBA INTERGRATED MEDICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMS URGENT CARE DBA INTERGRATED MEDICAL 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:
INTEGRATED MEDICAL SERVICES, INC.
Provider Other Organization Name Type Code:
3
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:
1629411046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9250 N 3RD ST STE 4010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85020-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-633-3838
Provider Business Mailing Address Fax Number:
602-633-3850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3540 E BASELINE RD
Provider Second Line Business Practice Location Address:
131
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85042-9627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-251-7559
Provider Business Practice Location Address Fax Number:
480-621-7043
Provider Enumeration Date:
04/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DOVER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
602-824-3370

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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