Provider Demographics
NPI:1093102121
Name:IWC HEALTH SOLUTIONS LLC
Entity Type:Organization
Organization Name:IWC HEALTH SOLUTIONS LLC
Other - Org Name:INTEGRITY HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-504-1437
Mailing Address - Street 1:12221 MERIT DR
Mailing Address - Street 2:SUITE 620
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2202
Mailing Address - Country:US
Mailing Address - Phone:214-506-2061
Mailing Address - Fax:972-681-8727
Practice Address - Street 1:920 S BELT LINE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4531
Practice Address - Country:US
Practice Address - Phone:469-554-9396
Practice Address - Fax:214-206-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00194619OtherRR MEDICARE
TX8M8933OtherBCBS
TX127663608Medicaid
TX127663607Medicaid
TX127663609Medicaid
TXTXB160497Medicare PIN
F88548Medicare UPIN
TX8D3889Medicare PIN
TX8L4370Medicare PIN