Provider Demographics
NPI:1508679127
Name:INTEGRATIVE CARDIOVASCULAR CARE PLLC
Entity type:Organization
Organization Name:INTEGRATIVE CARDIOVASCULAR CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RALPH WILLIAM
Authorized Official - Last Name:KNELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-496-4494
Mailing Address - Street 1:1539 W LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-4131
Mailing Address - Country:US
Mailing Address - Phone:509-496-4494
Mailing Address - Fax:
Practice Address - Street 1:660 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-0022
Practice Address - Country:US
Practice Address - Phone:509-496-4494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty