Healthcare Provider Details

I. General information

NPI: 1821289372
Provider Name (Legal Business Name): INTEGRATIVE MEDICAL CENTERS OF OHIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W MAIN STREET
CORTLAND OH
44410-1432
US

IV. Provider business mailing address

148 W MAIN STREET
CORTLAND OH
44410-1432
US

V. Phone/Fax

Practice location:
  • Phone: 330-638-7310
  • Fax: 330-638-7257
Mailing address:
  • Phone: 330-638-7310
  • Fax: 330-638-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number812
License Number StateOH

VIII. Authorized Official

Name: DR. THOMAS PAUL MONTGOMERY
Title or Position: DIRECTOR
Credential: DC
Phone: 330-638-7310