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NPI Code Detail

MEDICARE: INTEGRATED MEDICAL GROUP

MEDICARE: INTEGRATED MEDICAL GROUP
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
1363L00000XNurse PractitionerCO
2207Q00000XFamily Medicine PhysicianCO

General Provider Information

NPI Number : 1700273083
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATED MEDICAL GROUP
Provider Business Mailing Address
First Line : 2244 E HARMONY RD STE 110
Second Line :
City : FORT COLLINS
State : CO
Zip : 80528-3422
Country : US
Telephone Number : 970-226-1117
Fax Number : 970-226-0251
Provider Business Practice Location Address
First Line : 2244 E HARMONY RD STE 110
Second Line :
City : FORT COLLINS
State : CO
Zip : 80528-3422
Country : US
Telephone Number : 970-226-1117
Fax Number : 970-226-0251
Authorized Official
Title or Position : CFO
Name : MS. TARRYN LEIGH FARRELL
Credential :
Telephone Number : 970-226-1117
Provider Enumeration Date : 04/23/2015
Last Update Date : 02/22/2018

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Directions to “INTEGRATED MEDICAL GROUP ” Practice Location

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