Provider Demographics
NPI:1275924318
Name:VALLEY INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:VALLEY INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-556-1061
Mailing Address - Street 1:2702 BRAMBLETON AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-4308
Mailing Address - Country:US
Mailing Address - Phone:540-556-1061
Mailing Address - Fax:
Practice Address - Street 1:2702 BRAMBLETON AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-5139
Practice Address - Country:US
Practice Address - Phone:540-556-1061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
VA0102202320305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty