Provider Demographics
NPI:1619407269
Name:INTEGRATIVE NATURAL MEDICINE
Entity Type:Organization
Organization Name:INTEGRATIVE NATURAL MEDICINE
Other - Org Name:THE MERIDIAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DNM, PA
Authorized Official - Phone:480-521-2775
Mailing Address - Street 1:2025 E CAMPBELL AVE
Mailing Address - Street 2:#259
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016
Mailing Address - Country:US
Mailing Address - Phone:480-521-2775
Mailing Address - Fax:
Practice Address - Street 1:2025 E CAMPBELL AVE
Practice Address - Street 2:#259
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8501
Practice Address - Country:US
Practice Address - Phone:480-521-2775
Practice Address - Fax:480-521-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5659363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty