Provider Demographics
NPI:1932094752
Name:PROFESSIONAL INTEGRATIVE CARE LLC
Entity type:Organization
Organization Name:PROFESSIONAL INTEGRATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-499-6863
Mailing Address - Street 1:4018 N HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8431
Mailing Address - Country:US
Mailing Address - Phone:614-618-0017
Mailing Address - Fax:614-635-9229
Practice Address - Street 1:4018 N HAMPTON DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8431
Practice Address - Country:US
Practice Address - Phone:614-618-0017
Practice Address - Fax:614-635-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care