Healthcare Provider Details

I. General information

NPI: 1255749982
Provider Name (Legal Business Name): INTEGRATED HEALTHCARE MOBILE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 E BASELINE RD STE A1
TEMPE AZ
85283-1527
US

IV. Provider business mailing address

PO BOX 308
QUEEN CREEK AZ
85142-1806
US

V. Phone/Fax

Practice location:
  • Phone: 480-718-5400
  • Fax: 877-666-4624
Mailing address:
  • Phone: 480-718-5400
  • Fax: 877-666-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: BROOKE W EISENHART
Title or Position: CEO
Credential: NP
Phone: 480-718-5400