Healthcare Provider Details

I. General information

NPI: 1215260971
Provider Name (Legal Business Name): INTEGRATIVE GYNECOLOGY AND WOMENS WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S. DENTON TAP RD SUITE 275
COPPELL TX
75019-5066
US

IV. Provider business mailing address

215 S. DENTON TAP RD SUITE 275
COPPELL TX
75019-5066
US

V. Phone/Fax

Practice location:
  • Phone: 972-393-1300
  • Fax: 972-393-1337
Mailing address:
  • Phone: 972-393-1300
  • Fax: 972-393-1337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberL1983
License Number StateTX

VIII. Authorized Official

Name: DR. COURTNEY PAIGE RIDLEY
Title or Position: OWNER
Credential: M.D.
Phone: 972-393-1300