MEDICARE: INTEGRACARELLC

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	261QP2300X	Primary Care Clinic/Center	04-37763	KS

General Provider Information

NPI Number	:	1750771606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRACARELLC

Provider Business Mailing Address
First Line	:	3020 N CYPRESS ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67226-4009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 KAREN AVE UNIT 3107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-0446
Country	:	US
Telephone Number	:	816-588-6896
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ELIZABETH HARBIN
Credential	:	MD
Telephone Number	:	816-588-6896

Provider Enumeration Date	:	01/30/2015
Last Update Date	:	01/30/2015

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Directions to “INTEGRACARELLC ” Practice Location

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