Provider Demographics
NPI:1043887441
Name:TEXAS INTEGRATED HEALTHCARE PLLC
Entity Type:Organization
Organization Name:TEXAS INTEGRATED HEALTHCARE PLLC
Other - Org Name:CENTRAL MIND AND MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOMEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, AGPCNP, PMHNP
Authorized Official - Phone:254-624-2735
Mailing Address - Street 1:1005 MARLANDWOOD RD STE 116
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3339
Mailing Address - Country:US
Mailing Address - Phone:254-624-2735
Mailing Address - Fax:
Practice Address - Street 1:1005 MARLANDWOOD RD STE 116
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3339
Practice Address - Country:US
Practice Address - Phone:254-624-2735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-05
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01Other01