Organization Active NPI

Viverant Integrative Clinic LLC

Doing business as Viverant Integrative Clinic

  • Family Medicine Physician
  • Jeffersonville, IN
National Provider Identifier
1255943767
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
VIVERANT INTEGRATIVE CLINIC LLC
Doing business as
Viverant Integrative Clinic
Practice address
335 Spring St Ste B
Jeffersonville, IN 47130-4480
Phone
(812) 255-1699
NPI assigned
Aug 18, 2020
Last updated
Apr 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Authorized official

Name
Jo Leigh Holland
Title
Owner
Phone
(812) 255-1699

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Infusion Therapy Clinic/Center 261QI0500X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

335 Spring St Ste B
Jeffersonville, IN 47130-4480

Mailing address

300 Spring St Ste 3B
Jeffersonville, IN 47130-3498
Phone (812) 255-1699

Other names 1

  • Viverant Integrative Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211115002089 IN Part B Supplier - Clinic/Group Practice 3476942350 Receives reassigned benefits from 3 practitioners
Practice locations: Jeffersonville, IN

National Provider Directory

National Provider Directory

Locations

335 Spring St
Ste B
Jeffersonville, IN 47130
Phone (812) 255-1699

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1255943767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SPRING ST STE 3B",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471303498",
            "telephone_number": "812-255-1699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 SPRING ST STE B",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471304480",
            "telephone_number": "812-255-1699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVERANT INTEGRATIVE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-18",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "JO",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-255-1699"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Viverant Integrative Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Viverant Integrative Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jeffersonville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.