Healthcare Provider Details

I. General information

NPI: 1750636650
Provider Name (Legal Business Name): INTEGRATED MEDICAL CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 N. GRANT AVE.
LOVELAND CO
80538-8412
US

IV. Provider business mailing address

PO BOX 574
GRETNA NE
68028-0574
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-9451
  • Fax: 877-535-9359
Mailing address:
  • Phone: 970-221-9451
  • Fax: 877-535-9359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35700
License Number StateCO

VIII. Authorized Official

Name: DAVID FEEBACK
Title or Position: PRACTICE ADMINISTRATOR
Credential: PRACTICE ADMINISTRAT
Phone: 970-221-9451