MEDICARE: CITIZENS INTEGRATED MEDICAL SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363LA2100X	Acute Care Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner
3	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497379069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITIZENS INTEGRATED MEDICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	1530 E WILLIAMS FIELD RD STE 201
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-1825
Country	:	US
Telephone Number	:	480-406-1132
Fax Number	:	480-613-2912

Provider Business Practice Location Address
First Line	:	1530 E WILLIAMS FIELD RD STE 201
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-1825
Country	:	US
Telephone Number	:	480-406-1132
Fax Number	:	480-613-2912

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. NOAH SANG
Credential	:	AGACNP-C, FNP-C
Telephone Number	:	480-992-1455

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	10/13/2022

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