Basic Information
| Provider Information | |||||||||
| NPI: | 1255749982 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED HEALTHCARE MOBILE SOLUTIONS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 308 | ||||||||
| Address2: | |||||||||
| City: | QUEEN CREEK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851421806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807185400 | ||||||||
| FaxNumber: | 8776664624 | ||||||||
| Practice Location | |||||||||
| Address1: | 1840 E BASELINE RD STE A1 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852831527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807185400 | ||||||||
| FaxNumber: | 8776664624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2014 | ||||||||
| LastUpdateDate: | 01/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | EISENHART | ||||||||
| AuthorizedOfficialFirstName: | BROOKE | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4807185400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 213E00000X | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 363LF0000X | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.