Healthcare Provider Details

I. General information

NPI: 1306183538
Provider Name (Legal Business Name): PREFERRED CENTER FOR INTEGRATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 COUNTRY CLUB RD SUITE B
COLUMBUS OH
43213
US

IV. Provider business mailing address

1021 COUNTRY CLUB RD SUITE B
COLUMBUS OH
43213
US

V. Phone/Fax

Practice location:
  • Phone: 614-762-7312
  • Fax: 888-551-2775
Mailing address:
  • Phone: 614-762-7312
  • Fax: 888-551-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34006525
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number3578117
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number3578117
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number3578117
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35-049187
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number51012577
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC.2170
License Number StateOH
# 8
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3578117
License Number StateOH

VIII. Authorized Official

Name: MS. SOPHIA SIPES
Title or Position: PRACTICE ADMINISTRATOR
Credential: MBA
Phone: 614-762-7312