Healthcare Provider Details

I. General information

NPI: 1497379069
Provider Name (Legal Business Name): CITIZENS INTEGRATED MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E WILLIAMS FIELD RD STE 201
GILBERT AZ
85295-1825
US

IV. Provider business mailing address

1530 E WILLIAMS FIELD RD STE 201
GILBERT AZ
85295-1825
US

V. Phone/Fax

Practice location:
  • Phone: 480-406-1132
  • Fax: 480-613-2912
Mailing address:
  • Phone: 480-406-1132
  • Fax: 480-613-2912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. NOAH SANG
Title or Position: ADMINISTRATOR
Credential: AGACNP-C, FNP-C
Phone: 480-992-1455