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General NPI Number Information
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NPI Number | 1538974977
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE PRIMARY CARE INC
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 116 W LAFAYETTE ST STE 1
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City | OTTAWA
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State | IL
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Zip | 61350-2160
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Country | US
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Telephone | 815-503-9113
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Fax |
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Provider Business Mailing Address
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Address Line | 4350 MAHONEY DR # 1007
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City | PERU
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State | IL
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Zip | 61354-1164
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Country | US
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Telephone | 815-503-9113
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE HERMOSILLO
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Credential | APRN
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Telephone | 815-503-9113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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