Healthcare Provider Details

I. General information

NPI: 1568743375
Provider Name (Legal Business Name): INTEGRATED MEDICAL SERVICES COV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N HIGHWAY 190
COVINGTON LA
70433-5016
US

IV. Provider business mailing address

PO BOX 1602
MANDEVILLE LA
70470-1602
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-2223
  • Fax:
Mailing address:
  • Phone: 985-893-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberLA024908
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN102334-AP06140
License Number StateLA

VIII. Authorized Official

Name: NELSON J CURTIS III
Title or Position: MANAGING MEMBER
Credential:
Phone: 504-723-8361