Healthcare Provider Details

I. General information

NPI: 1578012308
Provider Name (Legal Business Name): INTEGRATED MEDICAL PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date: 02/27/2019
Reactivation Date: 11/28/2022

III. Provider practice location address

1301 S CRISMON RD
MESA AZ
85209-3767
US

IV. Provider business mailing address

PO BOX 51510
MESA AZ
85208-0076
US

V. Phone/Fax

Practice location:
  • Phone: 480-261-5319
  • Fax:
Mailing address:
  • Phone: 480-863-4961
  • Fax: 480-863-1588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DARLENE JARVINA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 480-863-5961