Provider Demographics
NPI:1285021196
Name:INTEGRITY WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:INTEGRITY WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEBUM
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-695-8749
Mailing Address - Street 1:3004 COMMUNICATIONS PKWY STE 200-146
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8909
Mailing Address - Country:US
Mailing Address - Phone:972-435-4070
Mailing Address - Fax:
Practice Address - Street 1:920 S BELT LINE RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4531
Practice Address - Country:US
Practice Address - Phone:469-307-5104
Practice Address - Fax:469-307-5113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical