Healthcare Provider Details

I. General information

NPI: 1619242575
Provider Name (Legal Business Name): INTEGRATED MEDICAL SERVICES HAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W MINNESOTA PARK RD
HAMMOND LA
70403-6149
US

IV. Provider business mailing address

PO BOX 716
MANDEVILLE LA
70470-0716
US

V. Phone/Fax

Practice location:
  • Phone: 985-350-6110
  • Fax: 985-350-6109
Mailing address:
  • Phone: 504-723-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NELSON JAMES CURTIS III
Title or Position: MANAGING MEMBER/OWNER
Credential:
Phone: 504-723-8399