Basic Information
| Provider Information | |||||||||
| NPI: | 1295063212 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTEGRAL PRIMARY CARE INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2311 10TH AVE N STE 14 | ||||||||
| Address2: | |||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334616605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615865326 | ||||||||
| FaxNumber: | 5615867237 | ||||||||
| Practice Location | |||||||||
| Address1: | 27 NE 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330606609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549421290 | ||||||||
| FaxNumber: | 9549425067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2009 | ||||||||
| LastUpdateDate: | 12/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | BETANCES | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5613861096 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.