Provider Demographics
NPI:1881603645
Name:INTEGRATED MEDICAL CENTER OF JUPITER, PA
Entity type:Organization
Organization Name:INTEGRATED MEDICAL CENTER OF JUPITER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-747-7707
Mailing Address - Street 1:920 W INDIANTOWN RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6847
Mailing Address - Country:US
Mailing Address - Phone:561-747-7707
Mailing Address - Fax:561-748-5502
Practice Address - Street 1:920 W INDIANTOWN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6847
Practice Address - Country:US
Practice Address - Phone:561-747-7707
Practice Address - Fax:561-748-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2347Medicare ID - Type Unspecified