MEDICARE: TEXAS INTEGRATED CARE GROUP, 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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1124982863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS INTEGRATED CARE GROUP, PLLC

Provider Business Mailing Address
First Line	:	186 MOON DANCE CT
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2240
Country	:	US
Telephone Number	:	469-267-1172
Fax Number	:

Provider Business Practice Location Address
First Line	:	186 MOON DANCE CT
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2240
Country	:	US
Telephone Number	:	469-267-1172
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	BASIL NDUMA
Credential	:	MD
Telephone Number	:	469-267-1172

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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