Integrative Medicine Center. LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

U00872 Issued in MD

Legal business name

INTEGRATIVE MEDICINE CENTER. LLC

Practice address

1140 Professional CT
Hagerstown, MD 21740-5852

Phone

(240) 420-8625

Fax

(240) 420-8627

NPI assigned

Feb 13, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert Lewis Bastress II, L.AC.

Title

Owner

Phone

(240) 420-8625

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1234483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234483200000",
    "number": "1124267281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 PROFESSIONAL CT",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405852",
            "telephone_number": "240-420-8625",
            "fax_number": "240-420-8627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 PROFESSIONAL CT",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405852",
            "telephone_number": "240-420-8625",
            "fax_number": "240-420-8627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE MEDICINE CENTER. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-13",
        "last_updated": "2009-02-13",
        "status": "A",
        "authorized_official_last_name": "BASTRESS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LEWIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-420-8625",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "L.AC."
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "MD",
            "license": "U00872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.