Healthcare Provider Details

I. General information

NPI: 1568224095
Provider Name (Legal Business Name): IEMD HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 EDDIE DOWLING HWY
NORTH SMITHFIELD RI
02896-7327
US

IV. Provider business mailing address

PO BOX 68
OSCEOLA MILLS PA
16666-0068
US

V. Phone/Fax

Practice location:
  • Phone: 814-339-7101
  • Fax:
Mailing address:
  • Phone: 814-339-7101
  • Fax: 814-339-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN MILLS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 814-577-9385