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NPI Code Detail

MEDICARE: INTEGRA MEDICAL CLINIC PLLC

MEDICARE: INTEGRA MEDICAL CLINIC PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianP5722TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100M0Z4OTHERTXBCBS

General Provider Information

NPI Number : 1518413806
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRA MEDICAL CLINIC PLLC
Provider Business Mailing Address
First Line : 12000 RICHMOND AVE,
Second Line : SUITE 330
City : HOUSTON
State : TX
Zip : 77082-2428
Country : US
Telephone Number : 713-334-2330
Fax Number : 713-334-0552
Provider Business Practice Location Address
First Line : 12000 RICHMOND AVE,
Second Line : SUITE 330
City : HOUSTON
State : TX
Zip : 77082-2428
Country : US
Telephone Number : 713-334-2330
Fax Number : 713-334-0552
Authorized Official
Title or Position : OFFICE MANGER
Name : DELIA LILA SALINAS
Credential : MD
Telephone Number : 713-334-0530
Provider Enumeration Date : 08/28/2016
Last Update Date : 04/01/2019

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Directions to “INTEGRA MEDICAL CLINIC PLLC ” Practice Location

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