Integrative Wellness Center

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

9500440 Issued in NC

Legal business name

INTEGRATIVE WELLNESS CENTER

Practice address

1703 Davie Ave
Statesville, NC 28677-3521

Phone

(980) 223-8535

Fax

(980) 223-8585

NPI assigned

Jun 10, 2014

Last updated

Jul 16, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Susan Lovejoy Roque, M.D.

Title

Owner

Phone

(980) 223-8535

Specialties & licenses 2

Addresses

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12109/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405468800000",
    "number": "1518370261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 DAVIE AVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773521",
            "telephone_number": "980-223-8535",
            "fax_number": "980-223-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 DAVIE AVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773521",
            "telephone_number": "980-223-8535",
            "fax_number": "980-223-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-10",
        "last_updated": "2014-07-16",
        "status": "A",
        "authorized_official_last_name": "ROQUE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "LOVEJOY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "980-223-8535",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "161312",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "9500440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Statesville, NC
• Providers in Statesville, NC by specialty
• Obstetrics & Gynecology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; 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.