1215284666 NPI number — INTEGRATED INJURY MANAGEMENT SERVICES INC

Table of content: (NPI 1215284666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215284666 NPI number — INTEGRATED INJURY MANAGEMENT SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED INJURY MANAGEMENT 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:
1215284666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92516-2367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-515-4552
Provider Business Mailing Address Fax Number:
800-515-4552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 ADAMS ST
Provider Second Line Business Practice Location Address:
C130
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92504-4335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-515-4552
Provider Business Practice Location Address Fax Number:
800-515-4552
Provider Enumeration Date:
08/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LAWSON
Authorized Official First Name:
TERENCE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-515-4552

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  1761 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: 11970 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com