# INTEGRATED MEDICAL GROUP EASTERN REGION INC

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

## Provider details

- **NPI number:** 1760815922
- **Authorized official:** MR. AMANDO OBA SILVA JR. (PRESIDENT)
- **Authorized official phone:** (224) 558-9705

## Contact information

- **Practice address:** 3230 S BUFFALO DR, SUITE 105, LAS VEGAS, NV 89117-2505
- **Practice address phone:** (224) 558-9705
- **Practice address fax:** (702) 990-7371
- **Mailing address:** 9957 MOORINGS DR, SUITE 204, JACKSONVILLE, FL 32257-2412
- **Mailing address phone:** (224) 558-9705
- **Mailing address fax:** (702) 990-7371

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 305R00000X | Preferred Provider Organization | P13000057299 | FL | — |
| 363L00000X | Nurse Practitioner | P13000057299 | FL | Yes |

## Other

- **Enumeration date:** 08/12/2013
- **Last updated:** 08/12/2013