Provider Demographics
NPI:1962493700
Name:INTEGRATED HEALTH CONCEPTS, INC.
Entity Type:Organization
Organization Name:INTEGRATED HEALTH CONCEPTS, INC.
Other - Org Name:CONVERSIO HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-395-6726
Mailing Address - Street 1:720 AEROVISTA PL
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-8726
Mailing Address - Country:US
Mailing Address - Phone:866-239-3784
Mailing Address - Fax:800-977-9255
Practice Address - Street 1:720 AEROVISTA PL
Practice Address - Street 2:SUITE D
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-8726
Practice Address - Country:US
Practice Address - Phone:866-239-3784
Practice Address - Fax:800-977-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 51610332B00000X
CAPHY46553333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD510550100Medicaid
TN1514775Medicaid
AZ482881Medicaid
FL8870600Medicaid
UT1962493700Medicaid
NM26080079Medicaid
KY7100224530Medicaid
PA1027478940001Medicaid
CAPHA465530Medicaid
OH3011412Medicaid
VA1962493700Medicaid
TX2980690Medicaid
KY7100224530Medicaid
CAPHA465530Medicaid
OH3011412Medicaid