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General NPI Number Information
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NPI Number | 1619242575
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Entity Type | Organization
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Legal Business Name | INTEGRATED MEDICAL SERVICES HAM, LLC
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Dates
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Enumeration Date | 03/12/2012
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 303 W MINNESOTA PARK RD
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City | HAMMOND
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State | LA
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Zip | 70403-6149
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Country | US
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Telephone | 985-350-6110
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Fax | 985-350-6109
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Provider Business Mailing Address
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Address Line | PO BOX 716
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City | MANDEVILLE
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State | LA
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Zip | 70470-0716
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Country | US
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Telephone | 504-723-8399
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER/OWNER
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Name | NELSON JAMES CURTIS III
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Credential |
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Telephone | 504-723-8399
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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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