Healthcare Provider Details

I. General information

NPI: 1851542013
Provider Name (Legal Business Name): INTENSIVO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL DR
ALTON IL
62002-6722
US

IV. Provider business mailing address

PO BOX 790379
SAINT LOUIS MO
63179-0379
US

V. Phone/Fax

Practice location:
  • Phone: 314-989-9122
  • Fax: 636-333-4510
Mailing address:
  • Phone: 314-989-9122
  • Fax: 636-333-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SALVADOR LOBIANCO
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 149-899-1223