Provider Demographics
NPI:1962583443
Name:INTEGRATIVE MEDICINE PHYSICIAN CENTER PC
Entity type:Organization
Organization Name:INTEGRATIVE MEDICINE PHYSICIAN CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-540-8594
Mailing Address - Street 1:PO BOX 60762
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17106
Mailing Address - Country:US
Mailing Address - Phone:717-540-8594
Mailing Address - Fax:717-540-9093
Practice Address - Street 1:4300 DEVONSHIRE RD STE 1
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-1540
Practice Address - Country:US
Practice Address - Phone:717-540-8594
Practice Address - Fax:717-540-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAK000014171100000X
PAMD064090L207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty