MEDICARE: INTEGRA OF THE WOODLANDS MEDICAL SERVICES, 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	207Q00000X	Family Medicine Physician	D7531	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0A3249	OTHER	TX	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649448101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRA OF THE WOODLANDS MEDICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 925188
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77292-5188
Country	:	US
Telephone Number	:	936-321-5600
Fax Number	:	936-271-5699

Provider Business Practice Location Address
First Line	:	3074 COLLEGE PARK DR
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77384-8002
Country	:	US
Telephone Number	:	936-321-5600
Fax Number	:	936-271-5699

Authorized Official
Title or Position	:	CEO
Name	:	REZIK A SAQER
Credential	:	MD
Telephone Number	:	936-321-5600

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	07/17/2011

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Directions to “INTEGRA OF THE WOODLANDS MEDICAL SERVICES, PLLC ” Practice Location

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