MEDICARE: NORTH HILLS INTEGRATIVE MEDICINE ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		NC

General Provider Information

NPI Number	:	1770760407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH HILLS INTEGRATIVE MEDICINE ASSOCIATES

Provider Business Mailing Address
First Line	:	4040 BARRETT DRIVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6640
Country	:	US
Telephone Number	:	919-783-5300
Fax Number	:	919-783-5007

Provider Business Practice Location Address
First Line	:	4040 BARRETT DRIVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6640
Country	:	US
Telephone Number	:	919-783-5300
Fax Number	:	919-783-5300

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DENISE HELENA SUTHERLAND-PHILLIPS
Credential	:	MD
Telephone Number	:	919-783-5300

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	02/05/2008

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