Provider Demographics
NPI:1851697734
Name:INTEGRATED HEALTH CARE CLINIC, LLC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER - CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CONGEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-690-6546
Mailing Address - Street 1:W236S7050 BIG BEND DR STE 6
Mailing Address - Street 2:
Mailing Address - City:BIG BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53103-9497
Mailing Address - Country:US
Mailing Address - Phone:262-436-1340
Mailing Address - Fax:262-436-9571
Practice Address - Street 1:W236S7050 BIG BEND DR STE 6
Practice Address - Street 2:
Practice Address - City:BIG BEND
Practice Address - State:WI
Practice Address - Zip Code:53103-9497
Practice Address - Country:US
Practice Address - Phone:262-436-1340
Practice Address - Fax:262-436-9571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service