Provider Demographics
NPI:1790956167
Name:CENTER FOR INTEGRATIVE MEDICINE, P.C.
Entity Type:Organization
Organization Name:CENTER FOR INTEGRATIVE MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JUMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-643-2000
Mailing Address - Street 1:1100 E 3RD ST
Mailing Address - Street 2:SUITE G-100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2201
Mailing Address - Country:US
Mailing Address - Phone:423-643-2246
Mailing Address - Fax:423-643-2030
Practice Address - Street 1:1100 E 3RD ST
Practice Address - Street 2:SUITE G-100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2201
Practice Address - Country:US
Practice Address - Phone:423-643-2246
Practice Address - Fax:423-643-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28299207Q00000X
TNMD36510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3726295Medicare PIN