Provider Demographics
NPI:1710400502
Name:CENTER OF INTEGRATIVE MEDICINE CORP
Entity Type:Organization
Organization Name:CENTER OF INTEGRATIVE MEDICINE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINAMRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-302-6420
Mailing Address - Street 1:9070 E DESERT COVE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6227
Mailing Address - Country:US
Mailing Address - Phone:713-302-6420
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:9070 E DESERT COVE AVE STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6227
Practice Address - Country:US
Practice Address - Phone:713-302-6420
Practice Address - Fax:859-344-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48655305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization