Basic Information
| Provider Information | |||||||||
| NPI: | 1588228712 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVOCATE INTEGRATED MEDICINE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 E WATAUGA AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376014629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233883643 | ||||||||
| FaxNumber: | 4233883561 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 E WATAUGA AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376014629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233883643 | ||||||||
| FaxNumber: | 4233883561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2019 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | DUNNE | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 4233883643 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081S0010X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |
No ID Information.