Provider Demographics
NPI:1073920096
Name:AMARO INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:AMARO INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:AMARO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:806-576-4999
Mailing Address - Street 1:1901 MEDI PARK DR
Mailing Address - Street 2:1048
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2110
Mailing Address - Country:US
Mailing Address - Phone:806-576-4999
Mailing Address - Fax:806-589-1062
Practice Address - Street 1:1901 MEDI PARK DR
Practice Address - Street 2:1048
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2110
Practice Address - Country:US
Practice Address - Phone:806-576-4999
Practice Address - Fax:806-589-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX291003YSJ1OtherTX PROVIDER ID (TPI)
TX320189901Medicaid
TX291003YSJ1OtherMEDICARE