Provider Demographics
NPI:1144628439
Name:INTEGRATIVE MEDICAL GROUP, USA, LLC
Entity type:Organization
Organization Name:INTEGRATIVE MEDICAL GROUP, USA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OZDEMIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-233-2888
Mailing Address - Street 1:1102 A1A NORTH
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082
Mailing Address - Country:US
Mailing Address - Phone:904-273-6533
Mailing Address - Fax:904-273-6532
Practice Address - Street 1:1102 A1A NORTH
Practice Address - Street 2:SUITE 104
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082
Practice Address - Country:US
Practice Address - Phone:904-273-6533
Practice Address - Fax:904-273-6532
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC ASSOCIATES OF JACKSONVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care