Provider Demographics
NPI:1124313986
Name:INTEGRATED MEDICINE NATUROPATHIC PRIMARY CARE
Entity type:Organization
Organization Name:INTEGRATED MEDICINE NATUROPATHIC PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:802-458-0488
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:EAST MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05740-0705
Mailing Address - Country:US
Mailing Address - Phone:802-458-0488
Mailing Address - Fax:802-458-0489
Practice Address - Street 1:1641 ROUTE 7 S
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8806
Practice Address - Country:US
Practice Address - Phone:802-458-0488
Practice Address - Fax:802-458-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099-0000230175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015227Medicaid