Provider Demographics
NPI:1144453739
Name:INTEGRATIVE MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:INTEGRATIVE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-375-7100
Mailing Address - Street 1:3650 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6656
Mailing Address - Country:US
Mailing Address - Phone:801-375-7100
Mailing Address - Fax:801-375-7102
Practice Address - Street 1:3650 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6656
Practice Address - Country:US
Practice Address - Phone:801-375-7100
Practice Address - Fax:801-375-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1659453694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty