| Organization Name: | INTEGRATED MEDICAL GROUP, LTD |
| NPI Number: | 1023175098 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID MICHAEL THAYER (OWNER) |
| Mailing Address: | 435-b South Buchanan St Edwardsville |
| State: | IL US |
| Postal Code: | 620252091 |
| Phone Number: | 6186926700 |
| Fax Number: | |
| NPI Enumeration Date: | 01/02/2007 |
| NPI Last Update Date: | 11/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |