Healthcare Provider Details

I. General information

NPI: 1023191210
Provider Name (Legal Business Name): INTEGRATED MEDICAL, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 S AKRON ST SUITE 320
CENTENNIAL CO
80112-3508
US

IV. Provider business mailing address

8100 S AKRON ST SUITE 320
CENTENNIAL CO
80112-3508
US

V. Phone/Fax

Practice location:
  • Phone: 303-792-0069
  • Fax: 303-792-0702
Mailing address:
  • Phone: 303-792-0069
  • Fax: 303-792-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number21-23918-0000
License Number StateCO

VIII. Authorized Official

Name: MS. HEATHER DEWEY
Title or Position: CONTROLLER
Credential:
Phone: 303-792-0069