Provider Demographics
NPI:1780902502
Name:INTEGRATIVE HEALTH CENTER, PA
Entity type:Organization
Organization Name:INTEGRATIVE HEALTH CENTER, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-414-7555
Mailing Address - Street 1:6617 HERITAGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8750
Mailing Address - Country:US
Mailing Address - Phone:972-412-7555
Mailing Address - Fax:972-412-7558
Practice Address - Street 1:6617 HERITAGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8750
Practice Address - Country:US
Practice Address - Phone:972-412-7555
Practice Address - Fax:972-412-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty