Healthcare Provider Details

I. General information

NPI: 1427472307
Provider Name (Legal Business Name): INTEGRAMED MEDICAL - KING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 S RAINBOW BLVD SUITE 300
LAS VEGAS NV
89118-1895
US

IV. Provider business mailing address

5320 S RAINBOW BLVD SUITE 300
LAS VEGAS NV
89118-1895
US

V. Phone/Fax

Practice location:
  • Phone: 702-892-9696
  • Fax:
Mailing address:
  • Phone: 702-892-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: JAMES T KING
Title or Position: PRESIDENT AND SECRETARY
Credential:
Phone: 702-892-9696