Healthcare Provider Details

I. General information

NPI: 1659023299
Provider Name (Legal Business Name): INTERGRATED MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MEDICAL CT STE 206
MARTINSBURG WV
25401-3854
US

IV. Provider business mailing address

1001 BERRYVILLE AVE
WINCHESTER VA
22601-5900
US

V. Phone/Fax

Practice location:
  • Phone: 540-779-0607
  • Fax: 540-784-4464
Mailing address:
  • Phone: 703-743-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISETTE DE LEON
Title or Position: COO/OFFICE MANAGER
Credential:
Phone: 703-743-4060