Provider Demographics
NPI:1225491426
Name:ASPIRE INTEGRATIVE HEALTH CLINIC
Entity Type:Organization
Organization Name:ASPIRE INTEGRATIVE HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIENGXAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAVONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-203-1723
Mailing Address - Street 1:2202 GATEWAY DR STE D
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6870
Mailing Address - Country:US
Mailing Address - Phone:334-203-1723
Mailing Address - Fax:
Practice Address - Street 1:2202 GATEWAY DR STE D
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6870
Practice Address - Country:US
Practice Address - Phone:334-203-1723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO. 1492261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care