Healthcare Provider Details

I. General information

NPI: 1841456761
Provider Name (Legal Business Name): INTEGRATED HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 ECLIPSE CTR
BELOIT WI
53511-3550
US

IV. Provider business mailing address

74 ECLIPSE CTR
BELOIT WI
53511-3550
US

V. Phone/Fax

Practice location:
  • Phone: 608-361-0311
  • Fax:
Mailing address:
  • Phone: 608-361-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: RICHARD A PERRY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 608-361-6130