Provider Demographics
NPI:1891102265
Name:ARIZONA INTEGRATED MEDICINE, LLC
Entity Type:Organization
Organization Name:ARIZONA INTEGRATED MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DBH
Authorized Official - Phone:520-907-1730
Mailing Address - Street 1:6336 N ORACLE RD STE 326276
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5480
Mailing Address - Country:US
Mailing Address - Phone:520-907-1730
Mailing Address - Fax:520-797-3250
Practice Address - Street 1:6336 N ORACLE RD STE 326-276
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5480
Practice Address - Country:US
Practice Address - Phone:520-907-1730
Practice Address - Fax:520-797-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty