# ADVANCED INTEGRATED MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033674916
- **Authorized official:** DEE STEVENS DC (OWNER/OPERATOR)
- **Authorized official phone:** (435) 764-1775

## Contact information

- **Practice address:** 1395 NW MAIN ST, BLACKFOOT, ID 83221-3936
- **Practice address phone:** (208) 785-0270
- **Practice address fax:** (208) 785-0683
- **Mailing address:** 1742 N 500 W APT 102, LOGAN, UT 84341-2875
- **Mailing address phone:** (435) 764-1775

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/05/2019
- **Last updated:** 06/18/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1962456681 | PERSONAL NPI | — |