Provider Demographics
NPI:1225685712
Name:INTEGRATIVE MEDICAL GROUP OF TEXAS
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICAL GROUP OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-447-9093
Mailing Address - Street 1:6905 WEST GATE BLVD. STE A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745
Mailing Address - Country:US
Mailing Address - Phone:512-447-9093
Mailing Address - Fax:
Practice Address - Street 1:6905 WEST GATE BLVD. STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-447-9093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty