Provider Demographics
NPI:1093815078
Name:GUPTA, D.O. & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:GUPTA, D.O. & ASSOCIATES, LLC
Other - Org Name:INTEGRA URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NITI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-861-5200
Mailing Address - Street 1:7447 N. MACARTHUR BLVD.
Mailing Address - Street 2:SUITE 190
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063
Mailing Address - Country:US
Mailing Address - Phone:972-861-5200
Mailing Address - Fax:972-861-5205
Practice Address - Street 1:7447 N. MACARTHUR BLVD.
Practice Address - Street 2:SUITE 190
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063
Practice Address - Country:US
Practice Address - Phone:972-861-5200
Practice Address - Fax:972-861-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TXJ2044261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00423ZMedicare PIN
TX00423ZOtherMEDICARE, PTAN