Provider Demographics
NPI:1710094404
Name:CENTER FOR INTEGRATED MEDICINE, PA
Entity Type:Organization
Organization Name:CENTER FOR INTEGRATED MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAC
Authorized Official - Middle Name:T
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-272-8858
Mailing Address - Street 1:8278 BELLAIRE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4091
Mailing Address - Country:US
Mailing Address - Phone:713-272-8858
Mailing Address - Fax:713-995-6142
Practice Address - Street 1:8278 BELLAIRE BLVD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4091
Practice Address - Country:US
Practice Address - Phone:713-272-8858
Practice Address - Fax:713-995-6142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6791207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty