Provider Demographics
NPI:1295230258
Name:CENTRE FOR INTEGRATIVE AND HOLISTIC MEDICINE
Entity type:Organization
Organization Name:CENTRE FOR INTEGRATIVE AND HOLISTIC MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUBINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-819-4723
Mailing Address - Street 1:528 W BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3313
Mailing Address - Country:US
Mailing Address - Phone:850-819-4723
Mailing Address - Fax:850-481-1976
Practice Address - Street 1:528 W BALDWIN RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3313
Practice Address - Country:US
Practice Address - Phone:850-777-3250
Practice Address - Fax:850-522-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty