Basic Information
| Provider Information | |||||||||
| NPI: | 1932491578 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLIED INTEGRATED CARE SPECIALISTS, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 S SEGUIN AVE | ||||||||
| Address2: | |||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781303914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104487700 | ||||||||
| FaxNumber: | 2104487703 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 S SEGUIN AVE | ||||||||
| Address2: | |||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781303914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104487700 | ||||||||
| FaxNumber: | 2104487703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2011 | ||||||||
| LastUpdateDate: | 02/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | PAK | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | HO | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2104487700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | TXB131235 | 01 | TX | MEDICARE PTAN | OTHER | 284236101 | 05 | TX | MEDICAID |