INTEGRATED MEDICAL WELLNESS CENTER LLC NPI 1194335802

NPI Information

NPI: 1194335802
Provider Name: INTEGRATED MEDICAL WELLNESS CENTER, LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 03D2195917

Address:
10184 W HAPPY VALLEY PKWY STE 180
PEORIA, AZ
ZIP 85383
Phone: (480) 289-8464
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INTEGRATED MEDICAL WELLNESS CENTER, LLC is a multi-specialty clinic center in Peoria, AZ. INTEGRATED MEDICAL WELLNESS CENTER, LLC NPI is 1194335802. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

10184 W HAPPY VALLEY PKWY STE 180
PEORIA, AZ
ZIP 85383-254
Phone: (480) 289-8464

The provider's authorized official is Andre Dreval .
The authorized official title is Managing Member and has the following contact phone number (602) 400-2800.

The CLIA number assigned to this NPI record is 03D2195917 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/6/2020 and was last updated on 8/23/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207RP1001X	Internal Medicine	Pulmonary Disease	No
2	261Q00000X	Clinic/Center		No
3	207K00000X	Allergy & Immunology		No
4	261QI0500X	Clinic/Center	Infusion Therapy	No
5	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	No
6	261QM1300X	Clinic/Center	Multi-Specialty	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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