1962493700 NPI number — INTEGRATED HEALTH CONCEPTS, INC.

Table of content: (NPI 1962493700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962493700 NPI number — INTEGRATED HEALTH CONCEPTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED HEALTH CONCEPTS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CONVERSIO HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962493700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 AEROVISTA PL
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401-8726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-239-3784
Provider Business Mailing Address Fax Number:
800-977-9255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 AEROVISTA PL
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93401-8726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-239-3784
Provider Business Practice Location Address Fax Number:
800-977-9255
Provider Enumeration Date:
11/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CLINE
Authorized Official First Name:
TAYLOR
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
940-395-6726

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  PHY 51610 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PHY46553 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 510550100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1514775 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 482881 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8870600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1962493700 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26080079 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100224530 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1027478940001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PHA465530 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3011412 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1962493700 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2980690 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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