Provider Demographics
NPI:1548344344
Name:TOTAL INTEGRATED HEALTH SERVICES
Entity type:Organization
Organization Name:TOTAL INTEGRATED HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEVIRGILIIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-262-3733
Mailing Address - Street 1:381 DEERFIELD RD
Mailing Address - Street 2:TOTAL INTEGRATED HEALTH SERVICES
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:828-262-3733
Mailing Address - Fax:828-264-7799
Practice Address - Street 1:381 DEERFIELD RD
Practice Address - Street 2:TOTAL INTEGRATED HEALTH SERVICES
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607
Practice Address - Country:US
Practice Address - Phone:828-262-3733
Practice Address - Fax:828-264-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928376Medicaid
080065815OtherRAILROAD MEDICARE
205904JMedicare ID - Type Unspecified
NC8928376Medicaid