Healthcare Provider Details

I. General information

NPI: 1124982863
Provider Name (Legal Business Name): TEXAS INTEGRATED CARE GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 MOON DANCE CT
CONROE TX
77304-2240
US

IV. Provider business mailing address

186 MOON DANCE CT
CONROE TX
77304-2240
US

V. Phone/Fax

Practice location:
  • Phone: 469-267-1172
  • Fax:
Mailing address:
  • Phone: 469-267-1172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BASIL NDUMA
Title or Position: MEMBER
Credential: MD
Phone: 469-267-1172