Healthcare Provider Details

I. General information

NPI: 1083236137
Provider Name (Legal Business Name): INTEGRITY WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 N CEDAR ST
LUMBERTON NC
28358-3928
US

IV. Provider business mailing address

2116 N CEDAR ST
LUMBERTON NC
28358-3928
US

V. Phone/Fax

Practice location:
  • Phone: 910-674-3030
  • Fax: 910-674-3051
Mailing address:
  • Phone: 910-674-3030
  • Fax: 910-674-3051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACEY MORENO- SILVA
Title or Position: PRESIDENT
Credential:
Phone: 276-252-8811