Organization
INTEGRATED MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOWELL BRAGG DC (OWNER)
(205) 519-4201
Entity
Organization
Contact information
Practice address
975 9TH AVE SW STE 200, BESSEMER, AL 35022-7839
(205) 519-4201
Mailing address
975 9TH AVE SW STE 200, BESSEMER, AL 35022-7839
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
512-26348
BLUE CROSS /BLUE SHIELD OF ALABAMA
—
Enumeration date
05/18/2020
Last updated
05/18/2020
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