Provider Demographics
NPI:1386448181
Name:INTEGRATED MEDICAL INCORPORATED
Entity type:Organization
Organization Name:INTEGRATED MEDICAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-755-8000
Mailing Address - Street 1:PO BOX 14740
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73113-0740
Mailing Address - Country:US
Mailing Address - Phone:405-755-8000
Mailing Address - Fax:405-755-8001
Practice Address - Street 1:11011 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2714
Practice Address - Country:US
Practice Address - Phone:918-878-7800
Practice Address - Fax:405-755-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care