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General NPI Number Information
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NPI Number | 1588158752
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Entity Type | Organization
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Legal Business Name | INTEGRATED MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 13300 OLD BLANCO RD STE 340
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City | SAN ANTONIO
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State | TX
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Zip | 78216-7737
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Country | US
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Telephone | 210-600-4105
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Fax |
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Provider Business Mailing Address
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Address Line | 13300 OLD BLANCO RD STE 340
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City | SAN ANTONIO
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State | TX
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Zip | 78216-7737
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Country | US
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Telephone | 210-600-4105
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLOTTE BALLARD
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Credential | ENP-BC
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Telephone | 210-600-4105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L1817
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP107832
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP107832
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP107832
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License Number State | TX
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