Provider Demographics
NPI:1932491578
Name:ALLIED INTEGRATED CARE SPECIALISTS, PA
Entity Type:Organization
Organization Name:ALLIED INTEGRATED CARE SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HO
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:210-448-7700
Mailing Address - Street 1:1860 S SEGUIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3914
Mailing Address - Country:US
Mailing Address - Phone:210-448-7700
Mailing Address - Fax:210-448-7703
Practice Address - Street 1:1860 S SEGUIN AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3914
Practice Address - Country:US
Practice Address - Phone:210-448-7700
Practice Address - Fax:210-448-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB131235OtherMEDICARE PTAN
TX284236101Medicaid