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General NPI Number Information
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NPI Number | 1578783239
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE MEDICAL ASSOCIATES, PLLC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 590 S TRADE ST
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City | TRYON
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State | NC
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Zip | 28782-3714
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Country | US
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Telephone | 828-859-0420
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Fax | 828-859-0422
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Provider Business Mailing Address
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Address Line | 590 S TRADE ST
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City | TRYON
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State | NC
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Zip | 28782-3714
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Country | US
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Telephone | 828-859-0420
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Fax | 828-859-0422
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CONNIE GENE ROSS
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Credential | MD
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Telephone | 828-859-0420
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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 |
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License Number State |
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