Healthcare Provider Details

I. General information

NPI: 1578783239
Provider Name (Legal Business Name): INTEGRATIVE MEDICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 S TRADE ST
TRYON NC
28782-3714
US

IV. Provider business mailing address

590 S TRADE ST
TRYON NC
28782-3714
US

V. Phone/Fax

Practice location:
  • Phone: 828-859-0420
  • Fax: 828-859-0422
Mailing address:
  • Phone: 828-859-0420
  • Fax: 828-859-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CONNIE GENE ROSS
Title or Position: PRESIDENT
Credential: MD
Phone: 828-859-0420