MEDICARE: INTEGRATED CARE LLC

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	111N00000X	Chiropractor	1469	NE
2	225100000X	Physical Therapist	2828	NE
3	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1255675138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED CARE LLC

Provider Business Mailing Address
First Line	:	4832 S 24TH ST
Second Line	:	SECOND FLOOR
City	:	OMAHA
State	:	NE
Zip	:	68107-2703
Country	:	US
Telephone Number	:	402-502-1819
Fax Number	:	402-315-9994

Provider Business Practice Location Address
First Line	:	4832 S 24TH STREET
Second Line	:	SECOND FLOOR
City	:	OMAHA
State	:	NE
Zip	:	68107-2703
Country	:	US
Telephone Number	:	402-502-1819
Fax Number	:	402-315-9994

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC ANDREW WASHKUHN
Credential	:
Telephone Number	:	402-502-1819

Provider Enumeration Date	:	11/16/2012
Last Update Date	:	02/06/2023

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Directions to “INTEGRATED CARE LLC ” Practice Location

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