Provider Demographics
NPI:1972728509
Name:INTEGRATED MEDICAL CENTER
Entity type:Organization
Organization Name:INTEGRATED MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:CSANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-333-7788
Mailing Address - Street 1:527 TUNXIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4442
Mailing Address - Country:US
Mailing Address - Phone:203-333-7788
Mailing Address - Fax:
Practice Address - Street 1:527 TUNXIS HILL RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4442
Practice Address - Country:US
Practice Address - Phone:203-333-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001538111N00000X
CT031959204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF36301Medicare UPIN