Healthcare Provider Details

I. General information

NPI: 1013830660
Provider Name (Legal Business Name): MEDICAL INTEGRATIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 LINDBERG DR STE E
SLIDELL LA
70458-8163
US

IV. Provider business mailing address

1806 LINDBERG DR STE E
SLIDELL LA
70458-8163
US

V. Phone/Fax

Practice location:
  • Phone: 769-926-5781
  • Fax:
Mailing address:
  • Phone: 769-926-5781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH T SANDERS
Title or Position: MEMBER MANAGER
Credential:
Phone: 769-926-5781