Provider Demographics
NPI:1538974977
Name:INTEGRATIVE PRIMARY CARE INC
Entity type:Organization
Organization Name:INTEGRATIVE PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMOSILLO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:815-503-9113
Mailing Address - Street 1:4350 MAHONEY DR # 1007
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1164
Mailing Address - Country:US
Mailing Address - Phone:815-503-9113
Mailing Address - Fax:
Practice Address - Street 1:116 W LAFAYETTE ST STE 1
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2160
Practice Address - Country:US
Practice Address - Phone:815-503-9113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care