Provider Demographics
NPI:1184024663
Name:FIBROLIVING LLC
Entity Type:Organization
Organization Name:FIBROLIVING LLC
Other - Org Name:INTEGRATIVE HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-856-9866
Mailing Address - Street 1:742 MAGNOLIA ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8903
Mailing Address - Country:US
Mailing Address - Phone:601-856-9866
Mailing Address - Fax:601-856-9824
Practice Address - Street 1:742 MAGNOLIA ST
Practice Address - Street 2:SUITE D
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8903
Practice Address - Country:US
Practice Address - Phone:601-856-9866
Practice Address - Fax:601-856-9824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528086915OtherPROVIDER PERSONAL NPI