Provider Demographics
NPI:1356676373
Name:INTERGRATED MEDICAL NETWORK
Entity Type:Organization
Organization Name:INTERGRATED MEDICAL NETWORK
Other - Org Name:CENTER FOR ALTERNATIVE HEALING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:CST LMT
Authorized Official - Phone:352-596-7887
Mailing Address - Street 1:8403 BALM ST
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34607-4419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8405 BALM ST
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34607-4419
Practice Address - Country:US
Practice Address - Phone:352-596-7887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6391208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC7897OtherBLUE CROSS BLUE SHIELD