Provider Demographics
NPI:1578783239
Name:INTEGRATIVE MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-859-0420
Mailing Address - Street 1:590 S TRADE ST
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-3714
Mailing Address - Country:US
Mailing Address - Phone:828-859-0420
Mailing Address - Fax:828-859-0422
Practice Address - Street 1:590 S TRADE ST
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-3714
Practice Address - Country:US
Practice Address - Phone:828-859-0420
Practice Address - Fax:828-859-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty