Provider Demographics
NPI:1215319017
Name:INTEGRIMED DIAGNOSTIC SERVICES, LLC
Entity type:Organization
Organization Name:INTEGRIMED DIAGNOSTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TELOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-944-4701
Mailing Address - Street 1:1450 W GRAND PKWY S
Mailing Address - Street 2:SUITE G-454
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8286
Mailing Address - Country:US
Mailing Address - Phone:281-944-4701
Mailing Address - Fax:
Practice Address - Street 1:16840 BUCCANEER LN
Practice Address - Street 2:SUITE 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2507
Practice Address - Country:US
Practice Address - Phone:281-944-4701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty