MEDICARE: PREFERRED CENTER FOR INTEGRATIVE MEDICINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	34006525	OH
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	3578117	OH
3	207V00000X	Obstetrics & Gynecology Physician	3578117	OH
4	208VP0000X	Pain Medicine Physician	3578117	OH
5	207X00000X	Orthopaedic Surgery Physician	35-049187	OH
6	2081P0004X	Spinal Cord Injury Medicine Physician	51012577	OH
7	111NN1001X	Nutrition Chiropractor	DC.2170	OH
8	208D00000X	General Practice Physician	3578117	OH

General Provider Information

NPI Number	:	1306183538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED CENTER FOR INTEGRATIVE MEDICINE LLC

Provider Business Mailing Address
First Line	:	1021 COUNTRY CLUB RD
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	OH
Zip	:	43213
Country	:	US
Telephone Number	:	614-762-7312
Fax Number	:	888-551-2775

Provider Business Practice Location Address
First Line	:	1021 COUNTRY CLUB RD
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	OH
Zip	:	43213
Country	:	US
Telephone Number	:	614-762-7312
Fax Number	:	888-551-2775

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MS. SOPHIA SIPES
Credential	:	MBA
Telephone Number	:	614-762-7312

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	10/14/2013

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