Provider Demographics
NPI:1851871214
Name:INTEGRATIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:LINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-632-5585
Mailing Address - Street 1:999 DIAMOND RDG STE 201
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6920
Mailing Address - Country:US
Mailing Address - Phone:573-632-5585
Mailing Address - Fax:573-634-2978
Practice Address - Street 1:1002 DIAMOND RDG STE 1200
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-7911
Practice Address - Country:US
Practice Address - Phone:573-632-5585
Practice Address - Fax:844-736-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty