Provider Demographics
NPI:1629532452
Name:INTEGRATIVE FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:INTEGRATIVE FAMILY MEDICINE LLC
Other - Org Name:INTEGRATIVE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, NP-C
Authorized Official - Phone:304-516-1281
Mailing Address - Street 1:638 MCCARTNEY RD
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-4516
Mailing Address - Country:US
Mailing Address - Phone:304-516-1281
Mailing Address - Fax:
Practice Address - Street 1:638 MCCARTNEY RD
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-4516
Practice Address - Country:US
Practice Address - Phone:304-516-1281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty