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General NPI Number Information
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NPI Number | 1568743375
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Entity Type | Organization
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Legal Business Name | INTEGRATED MEDICAL SERVICES COV LLC
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 09/07/2011
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Provider Practice Location Address
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Address Line | 301 N HIGHWAY 190
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City | COVINGTON
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State | LA
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Zip | 70433-5016
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Country | US
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Telephone | 985-893-2223
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1602
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City | MANDEVILLE
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State | LA
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Zip | 70470-1602
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Country | US
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Telephone | 985-893-2223
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | NELSON J CURTIS III
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Credential |
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Telephone | 504-723-8361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN102334-AP06140
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | LA024908
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License Number State | LA
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