Provider Demographics
NPI:1093237125
Name:INTEGRATED MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:PETER M
Authorized Official - Last Name:UY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-438-5008
Mailing Address - Street 1:510 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5217
Mailing Address - Country:US
Mailing Address - Phone:256-438-5008
Mailing Address - Fax:256-467-4009
Practice Address - Street 1:510 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5217
Practice Address - Country:US
Practice Address - Phone:256-438-5008
Practice Address - Fax:256-467-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32263207Q00000X
ALMD31385207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty