# MAD RIVER INTEGRATIVE MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124239199
- **Authorized official:** TIM WARGO (OWNER)
- **Authorized official phone:** (802) 496-2202

## Contact information

- **Practice address:** 5360 MAIN ST, SUITE 2, WAITSFIELD, VT 05673-6003
- **Practice address phone:** (802) 496-2202
- **Mailing address:** 5360 MAIN ST, SUITE 2, WAITSFIELD, VT 05673-6003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/24/2007
- **Last updated:** 10/27/2007