MEDICARE: INTEGRATED CARE PHYSICIANS PLLC

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
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1609702158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED CARE PHYSICIANS PLLC

Provider Business Mailing Address
First Line	:	2375 E CAMELBACK RD STE 600
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-3493
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 ALAMO AVE SE STE 300
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-3523
Country	:	US
Telephone Number	:	602-387-4001
Fax Number	:	615-479-9760

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	KIRK STANLEY
Credential	:
Telephone Number	:	602-387-4001

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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