Healthcare Provider Details

I. General information

NPI: 1154591923
Provider Name (Legal Business Name): INTEGRATED MEDICAL CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 EASTERN AVE STE B1
FAIRMOUNT HEIGHTS MD
20743-1677
US

IV. Provider business mailing address

525 EASTERN AVE STE B1
FAIRMOUNT HEIGHTS MD
20743-1677
US

V. Phone/Fax

Practice location:
  • Phone: 301-333-3770
  • Fax: 301-333-3779
Mailing address:
  • Phone: 301-333-3770
  • Fax: 301-333-3779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL DENISE JONES
Title or Position: ADMINISTRATOR
Credential:
Phone: 301-333-3770