Healthcare Provider Details

I. General information

NPI: 1144471129
Provider Name (Legal Business Name): INTEGRATIVE MEDICAL SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 S SAINTS BLVD
EDMOND OK
73034-3051
US

IV. Provider business mailing address

PO BOX 269084
OKLAHOMA CITY OK
73126-9084
US

V. Phone/Fax

Practice location:
  • Phone: 405-348-2323
  • Fax: 405-348-2325
Mailing address:
  • Phone: 405-348-2323
  • Fax: 405-348-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateOK

VIII. Authorized Official

Name: WENDY PARKS
Title or Position: ADMINISTRATOR
Credential: A.R.N.P
Phone: 405-608-0443