Provider Demographics
NPI:1013261700
Name:INTEGRATIVE HEALTH CARE AND PHYSICAL MEDICINE OCALA LLC
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH CARE AND PHYSICAL MEDICINE OCALA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:BARE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-369-6325
Mailing Address - Street 1:3256 S PINE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6607
Mailing Address - Country:US
Mailing Address - Phone:352-369-6325
Mailing Address - Fax:352-369-6329
Practice Address - Street 1:3256 S PINE AVE STE 301
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6607
Practice Address - Country:US
Practice Address - Phone:352-369-6325
Practice Address - Fax:352-369-6329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110042207Q00000X
332B00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty