Provider Demographics
NPI:1780120501
Name:THE HEALTH CENTER FOR INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:THE HEALTH CENTER FOR INTEGRATIVE MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-906-4798
Mailing Address - Street 1:741 LOCUST AVENUE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2735
Mailing Address - Country:US
Mailing Address - Phone:724-906-4798
Mailing Address - Fax:724-918-9068
Practice Address - Street 1:741 LOCUST AVENUE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2735
Practice Address - Country:US
Practice Address - Phone:724-906-4798
Practice Address - Fax:724-918-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAK000186171100000X
PAMD064028L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1962453696OtherNPI (TYPE I)
PA0016929680001Medicaid
PAMD064028LOtherMEDICAL LICENSE
PA0016929680001Medicaid