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General NPI Number Information
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NPI Number | 1962583443
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE MEDICINE PHYSICIAN CENTER PC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 4300 DEVONSHIRE RD STE 1
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City | HARRISBURG
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State | PA
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Zip | 17109-1540
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Country | US
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Telephone | 717-540-8594
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Fax | 717-540-9093
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Provider Business Mailing Address
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Address Line | PO BOX 60762
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City | HARRISBURG
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State | PA
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Zip | 17106
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Country | US
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Telephone | 717-540-8594
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Fax | 717-540-9093
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSICA Y WILLIAMS
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Credential | MD
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Telephone | 717-540-8594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | PAK000014
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD064090L
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License Number State | PA
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