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Organization
ADVANCED INTEGRATED MEDICAL CENTER
Active
Organization
ADVANCED INTEGRATED MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEE STEVENS DC (OWNER/OPERATOR)
(435) 764-1775
Entity
Organization
Contact information
Practice address
1395 NW MAIN ST, BLACKFOOT, ID 83221-3936
(208) 785-0270
(208) 785-0683
Mailing address
1742 N 500 W APT 102, LOGAN, UT 84341-2875
(435) 764-1775
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962456681
PERSONAL NPI
—
Enumeration date
02/05/2019
Last updated
06/18/2020
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