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General NPI Number Information
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NPI Number | 1023260486
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Entity Type | Organization
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Legal Business Name | INTEGRATED HEALTH SERVICES INCORPORATED
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 10/20/2008
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Provider Practice Location Address
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Address Line | 2101 TOWER DR
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City | MONROE
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State | LA
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Zip | 71201-5045
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Country | US
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Telephone | 318-410-1044
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14282
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City | MONROE
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State | LA
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Zip | 71207-4282
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Country | US
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Telephone | 318-410-1044
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MS. ALICIA TENNANT
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Credential |
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Telephone | 318-410-1044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 07043R
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License Number State | LA
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