Healthcare Provider Details

I. General information

NPI: 1114289980
Provider Name (Legal Business Name): INTEGRATED MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S. 400 E #101
ST GEORGE UT
84770
US

IV. Provider business mailing address

616 S. RIVER RD #200 PO BOX 910855
ST GEORGE UT
84790-2105
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-9653
  • Fax: 435-673-9008
Mailing address:
  • Phone: 435-628-8944
  • Fax: 435-635-4506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CLIFF HOLT
Title or Position: OWNER
Credential:
Phone: 435-628-8944