Provider Demographics
NPI:1124066832
Name:INTEGRATIVE CARDIOLOGY CENTER PA
Entity type:Organization
Organization Name:INTEGRATIVE CARDIOLOGY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-841-1259
Mailing Address - Street 1:4140 MENDENHALL OAKS PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8034
Mailing Address - Country:US
Mailing Address - Phone:336-841-1259
Mailing Address - Fax:336-841-7595
Practice Address - Street 1:4140 MENDENHALL OAKS PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8034
Practice Address - Country:US
Practice Address - Phone:336-841-1259
Practice Address - Fax:336-841-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty