Provider Demographics
NPI:1467963751
Name:INTEGRATED INJURY SPECIALISTS
Entity type:Organization
Organization Name:INTEGRATED INJURY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALKCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-268-8607
Mailing Address - Street 1:PO BOX 61326
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-6044
Mailing Address - Country:US
Mailing Address - Phone:949-424-5840
Mailing Address - Fax:951-461-7074
Practice Address - Street 1:1041 E YORBA LINDA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3763
Practice Address - Country:US
Practice Address - Phone:949-424-3763
Practice Address - Fax:951-461-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty