MEDICARE: INTEGRATED MEDICAL SERVICES, INC.

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1629256219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED MEDICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	7405 VARNUM ST
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2311
Country	:	US
Telephone Number	:	301-674-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	7306 CENTRAL AVE
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-2773
Country	:	US
Telephone Number	:	301-674-0249
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JEAN A JONES
Credential	:	CMA
Telephone Number	:	301-674-0249

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	02/05/2008

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