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NPI Code Detail

MEDICARE: ADVANCED INTEGRATED MEDICAL LLC

MEDICARE: ADVANCED INTEGRATED MEDICAL LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0100XHealth Service Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11962456681OTHERUTOTHER INSURERS

General Provider Information

NPI Number : 1396369435
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED INTEGRATED MEDICAL LLC
Provider Business Mailing Address
First Line : 1635 N 200 E
Second Line :
City : LOGAN
State : UT
Zip : 84341-1913
Country : US
Telephone Number : 435-932-6138
Fax Number : 435-213-9325
Provider Business Practice Location Address
First Line : 1635 N 200 E
Second Line :
City : LOGAN
State : UT
Zip : 84341-1913
Country : US
Telephone Number : 435-932-6138
Fax Number : 435-213-9325
Authorized Official
Title or Position : MEMBER
Name : DEE S STEVENS
Credential : DC
Telephone Number : 435-764-1775
Provider Enumeration Date : 06/04/2020
Last Update Date : 06/29/2020

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Directions to “ADVANCED INTEGRATED MEDICAL LLC ” Practice Location

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