Provider Demographics
NPI:1053314237
Name:INTEGRATED CONCEPTS, INC
Entity type:Organization
Organization Name:INTEGRATED CONCEPTS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUNTINGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-345-9299
Mailing Address - Street 1:3807 ACADEMY PARKWAY S NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4410
Mailing Address - Country:US
Mailing Address - Phone:505-345-9299
Mailing Address - Fax:505-345-9902
Practice Address - Street 1:3807 ACADEMY PARKWAY S NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4410
Practice Address - Country:US
Practice Address - Phone:505-345-9299
Practice Address - Fax:505-345-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000L7182Medicaid
NM1158700001Medicare NSC