Provider Demographics
NPI:1376234401
Name:INTEGRAL PRIMARY CARE PRACTICE PLLC
Entity Type:Organization
Organization Name:INTEGRAL PRIMARY CARE PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-492-2324
Mailing Address - Street 1:435 SHREWSBURY ST STE NO227
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1689
Mailing Address - Country:US
Mailing Address - Phone:857-492-2324
Mailing Address - Fax:
Practice Address - Street 1:435 SHREWSBURY ST STE NO227
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1689
Practice Address - Country:US
Practice Address - Phone:857-492-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty