| Organization Name: | INTEGRATED HEALTH CARE CLINIC, LLC |
| NPI Number: | 1851697734 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CYNTHIA MARIE CONGEMI (BUSINESS MANAGER - CO-OWNER) |
| Mailing Address: | W231s7680 Big Bend Dr Big Bend |
| State: | WI US |
| Postal Code: | 531039686 |
| Phone Number: | 4146906546 |
| Fax Number: | |
| NPI Enumeration Date: | 02/09/2011 |
| NPI Last Update Date: | 02/09/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |