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General NPI Number Information
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NPI Number | 1346640208
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Entity Type | Organization
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Legal Business Name | GEORGETOWN INTEGRATED MEDICINE PSC
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 108 OSBOURNE WAY SUITE 6
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City | GEORGETOWN
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State | KY
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Zip | 40324-8887
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Country | US
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Telephone | 502-316-6533
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Fax |
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Provider Business Mailing Address
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Address Line | 7975 SOLUTION CTR
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City | CHICAGO
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State | IL
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Zip | 60677-7009
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Country | US
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Telephone | 859-559-0804
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BECKY SIZEMORE
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Credential |
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Telephone | 859-559-0804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 36483
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License Number State | KY
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