Provider Demographics
NPI:1154692317
Name:INTEGRAL MEDISYSTEM HEALTHCARE, LLC
Entity type:Organization
Organization Name:INTEGRAL MEDISYSTEM HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:LETIM
Authorized Official - Last Name:EBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-294-8242
Mailing Address - Street 1:8000 BRANCH HOLLOW TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-5002
Mailing Address - Country:US
Mailing Address - Phone:817-294-8242
Mailing Address - Fax:
Practice Address - Street 1:8000 BRANCH HOLLOW TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-5002
Practice Address - Country:US
Practice Address - Phone:817-294-8242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health