Integrated Medical Group Eastern Region Inc

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

P13000057299 Issued in FL

Legal business name

INTEGRATED MEDICAL GROUP EASTERN REGION INC

Practice address

3230 S Buffalo Dr
Suite 105
Las Vegas, NV 89117-2505

Phone

(224) 558-9705

Fax

(702) 990-7371

NPI assigned

Aug 12, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Amando Oba Silva Jr.

Title

President

Phone

(224) 558-9705

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376265600000",
    "number": "1760815922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9957 MOORINGS DR",
            "address_2": "SUITE 204",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322572412",
            "telephone_number": "224-558-9705",
            "fax_number": "702-990-7371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3230 S BUFFALO DR",
            "address_2": "SUITE 105",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891172505",
            "telephone_number": "224-558-9705",
            "fax_number": "702-990-7371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED MEDICAL GROUP EASTERN REGION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-12",
        "last_updated": "2013-08-12",
        "status": "A",
        "authorized_official_last_name": "SILVA",
        "authorized_official_first_name": "AMANDO",
        "authorized_official_middle_name": "OBA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "224-558-9705",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "FL",
            "license": "P13000057299",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "P13000057299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.