Healthcare Provider Details

I. General information

NPI: 1013261700
Provider Name (Legal Business Name): INTEGRATIVE HEALTH CARE AND PHYSICAL MEDICINE OCALA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3256 S PINE AVE STE 301
OCALA FL
34471-6607
US

IV. Provider business mailing address

3256 S PINE AVE STE 301
OCALA FL
34471-6607
US

V. Phone/Fax

Practice location:
  • Phone: 352-369-6325
  • Fax: 352-369-6329
Mailing address:
  • Phone: 352-369-6325
  • Fax: 352-369-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME110042
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. PRESTON KYLE BARE
Title or Position: OWNER/ DOCTOR
Credential: D.C.
Phone: 352-369-6325