Provider Demographics
NPI:1407462732
Name:EAST WEST INTEGRATED CARE CENTER LLC
Entity Type:Organization
Organization Name:EAST WEST INTEGRATED CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILDIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:BERCAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-993-6299
Mailing Address - Street 1:1100 W TUCSON ST APT 801
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-7246
Mailing Address - Country:US
Mailing Address - Phone:918-814-7650
Mailing Address - Fax:844-249-7650
Practice Address - Street 1:6703 E 81ST ST STE J
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4157
Practice Address - Country:US
Practice Address - Phone:918-814-7650
Practice Address - Fax:844-249-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty