Provider Demographics
NPI:1003008897
Name:ADVANCED INTEGRATIVE MEDICINE, PC
Entity Type:Organization
Organization Name:ADVANCED INTEGRATIVE MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SNOOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-708-0246
Mailing Address - Street 1:10455 PARK MEADOWS DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5414
Mailing Address - Country:US
Mailing Address - Phone:303-708-0246
Mailing Address - Fax:303-708-0247
Practice Address - Street 1:10455 PARK MEADOWS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5414
Practice Address - Country:US
Practice Address - Phone:303-708-0246
Practice Address - Fax:303-708-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty