Provider Demographics
NPI:1932268141
Name:INTEGRATIVE CENTER FOR HEALTH
Entity type:Organization
Organization Name:INTEGRATIVE CENTER FOR HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-472-8008
Mailing Address - Street 1:315 CANYON AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2677
Mailing Address - Country:US
Mailing Address - Phone:970-472-8008
Mailing Address - Fax:970-416-7739
Practice Address - Street 1:315 CANYON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2677
Practice Address - Country:US
Practice Address - Phone:970-472-8008
Practice Address - Fax:970-416-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC521248Medicare ID - Type Unspecified
COF73276Medicare UPIN