Provider Demographics
NPI:1649448101
Name:INTEGRA OF THE WOODLANDS MEDICAL SERVICES, PLLC
Entity type:Organization
Organization Name:INTEGRA OF THE WOODLANDS MEDICAL SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REZIK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAQER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-321-5600
Mailing Address - Street 1:PO BOX 925188
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77292-5188
Mailing Address - Country:US
Mailing Address - Phone:936-321-5600
Mailing Address - Fax:936-271-5699
Practice Address - Street 1:3074 COLLEGE PARK DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-8002
Practice Address - Country:US
Practice Address - Phone:936-321-5600
Practice Address - Fax:936-271-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2011-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2085193-01Medicaid
TX0A3249OtherMEDICARE PTAN
TXA65518Medicare PIN