OrganizationIntegrated Medical ClinicNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address7404 Executive Pl Ste 100, Lanham, MD 20706-6237(240) 758-1782(240) 260-3827PECOS EnrollmentBased on the most recent information from CMS, provider Integrated Medical Clinic does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 10:04 AM.Profile DetailsProvider ID1811578347Provider TypeOrganizationFull NameIntegrated Medical ClinicSubpartNoEnumeration Date4/16/2021Last Updated1/10/2024Contact InformationPractice LocationPractice Address7404 Executive Pl Ste 100, Lanham, MD 20706-6237Phone(240) 758-1782FaxUnlisted FaxMailing LocationMailing Address7404 Executive Pl Ste 100, Lanham, MD 20706-6237Phone(240) 260-3827Fax(240) 260-3830Authorized OfficialNameNguh, Olivia (Owner)Phone(410) 521-8000Provider TaxonomiesCodeDescriptionLicenseCode363LP0808XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerCode261QM0801XDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseUnlisted IssuerCode261QM0850XDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseUnlisted Issuer