Provider Demographics
NPI:1205397965
Name:WACO INTEGRATED MEDICAL PLLC
Entity Type:Organization
Organization Name:WACO INTEGRATED MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-537-1064
Mailing Address - Street 1:8300 OLD MCGREGOR RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3600
Mailing Address - Country:US
Mailing Address - Phone:254-537-1064
Mailing Address - Fax:254-537-1092
Practice Address - Street 1:8300 OLD MCGREGOR RD STE 2A
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-3600
Practice Address - Country:US
Practice Address - Phone:254-537-1064
Practice Address - Fax:254-537-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty