Provider Demographics
NPI:1831414838
Name:INTEGRANET-GULF COAST PA
Entity type:Organization
Organization Name:INTEGRANET-GULF COAST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:WEDEKIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-591-5265
Mailing Address - Street 1:2900 NORTH LOOP W STE 700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-8868
Mailing Address - Country:US
Mailing Address - Phone:281-447-6800
Mailing Address - Fax:
Practice Address - Street 1:2900 NORTH LOOP W STE 700
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8868
Practice Address - Country:US
Practice Address - Phone:281-447-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty