Provider Demographics
NPI:1477621282
Name:CENTER FOR INTEGRATIVE MEDICINE,PLLC
Entity Type:Organization
Organization Name:CENTER FOR INTEGRATIVE MEDICINE,PLLC
Other - Org Name:CENTER FOR INTEGRATIVE MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-747-7730
Mailing Address - Street 1:69 ALLEN ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701
Mailing Address - Country:US
Mailing Address - Phone:802-747-7730
Mailing Address - Fax:802-773-1609
Practice Address - Street 1:69 ALLEN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-747-7730
Practice Address - Fax:802-773-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTBUCK00001441OtherBCBS VT
VT1008528Medicaid
VT9492Medicare PIN