Provider Demographics
NPI:1154591923
Name:INTEGRATED MEDICAL CENTER, L.L.C.
Entity type:Organization
Organization Name:INTEGRATED MEDICAL CENTER, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-333-3770
Mailing Address - Street 1:525 EASTERN AVE STE B1
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1677
Mailing Address - Country:US
Mailing Address - Phone:301-333-3770
Mailing Address - Fax:301-333-3779
Practice Address - Street 1:525 EASTERN AVE STE B1
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-1677
Practice Address - Country:US
Practice Address - Phone:301-333-3770
Practice Address - Fax:301-333-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service