Provider Demographics
NPI:1770646937
Name:INTEGRACARE LTD
Entity Type:Organization
Organization Name:INTEGRACARE LTD
Other - Org Name:WILLIAMS INTEGRACARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RANDY
Authorized Official - Last Name:HALSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-251-2600
Mailing Address - Street 1:100 2ND ST S
Mailing Address - Street 2:PO BOX 296
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-1977
Mailing Address - Country:US
Mailing Address - Phone:320-251-2600
Mailing Address - Fax:320-251-4763
Practice Address - Street 1:100 2ND ST S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-1977
Practice Address - Country:US
Practice Address - Phone:320-251-2600
Practice Address - Fax:320-251-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCH337OtherRAILROAD MEDICARE
MN079858400Medicaid
MN31T18INOtherBCBS
MN70633OtherHEALTH PARTNERS
MNC02887Medicare ID - Type Unspecified
MN31T18INOtherBCBS