Provider Demographics
NPI:1821289372
Name:INTEGRATIVE MEDICAL CENTERS OF OHIO INC
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICAL CENTERS OF OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-638-7310
Mailing Address - Street 1:148 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1432
Mailing Address - Country:US
Mailing Address - Phone:330-638-7310
Mailing Address - Fax:330-638-7257
Practice Address - Street 1:148 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1432
Practice Address - Country:US
Practice Address - Phone:330-638-7310
Practice Address - Fax:330-638-7257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH812111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2366032Medicaid
OH2366032Medicaid