1023183043 NPI number — INTEGRATED PROFESSIONAL SERV LLC

Table of content: (NPI 1023183043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023183043 NPI number — INTEGRATED PROFESSIONAL SERV LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED PROFESSIONAL SERV LLC
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:
6
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:
1023183043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 651004
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84165-1004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-747-0921
Provider Business Mailing Address Fax Number:
801-747-0986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 E 4500 S
Provider Second Line Business Practice Location Address:
SUITE G-220
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-747-0921
Provider Business Practice Location Address Fax Number:
801-747-0986
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NABI
Authorized Official First Name:
IKHTIARUN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
801-747-0921

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  44633 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 470001928 . This is a "RR MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 606218700 . This is a "ACS US DEPT. OF LABOR" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000061972 . This is a "ALTIUS HEALTH PLANS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 51803040100001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 72595 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com