Provider Demographics
NPI:1346640208
Name:GEORGETOWN INTEGRATED MEDICINE PSC
Entity Type:Organization
Organization Name:GEORGETOWN INTEGRATED MEDICINE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-559-0804
Mailing Address - Street 1:7975 SOLUTION CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-7009
Mailing Address - Country:US
Mailing Address - Phone:859-559-0804
Mailing Address - Fax:
Practice Address - Street 1:108 OSBOURNE WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8887
Practice Address - Country:US
Practice Address - Phone:502-316-6533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36483207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty