Organization Name: | INTEGRATED MEDICAL PRACTICE |
NPI Number: | 1639517410 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JERRY HOLUBEC (OWNER) |
Mailing Address: | 4110 Fm 407 Suite 200 Lewisville |
State: | TX US |
Postal Code: | 750777269 |
Phone Number: | 9404552336 |
Fax Number: | 9404557359 |
NPI Enumeration Date: | 06/13/2013 |
NPI Last Update Date: | 12/02/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | E20221 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |