Provider Demographics
NPI:1235547134
Name:INTEGRATIVE CENTERS SCIENCE AND MEDICINE
Entity Type:Organization
Organization Name:INTEGRATIVE CENTERS SCIENCE AND MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-632-4276
Mailing Address - Street 1:315 HOSPITAL DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1945
Mailing Address - Country:US
Mailing Address - Phone:276-632-4276
Mailing Address - Fax:276-632-6355
Practice Address - Street 1:315 HOSPITAL DR
Practice Address - Street 2:SUITE 206
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1945
Practice Address - Country:US
Practice Address - Phone:276-632-4276
Practice Address - Fax:276-632-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241213207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty