| Integrative Medical Of Dfw Llc | |
|
670 N Macarthur Blvd Ste 100 Coppell TX 75019-2733 | |
| (972) 745-4446 | |
| Not Available |
| Full Name | Integrative Medical Of Dfw Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 670 N Macarthur Blvd Ste 100, Coppell, Texas |
| Authorized Official Name and Position | Derek Frye (OWNER) |
| Authorized Official Contact | 9723586526 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrative Medical Of Dfw Llc 670 N Macarthur Blvd Ste 100 Coppell TX 75019-2733 Ph: () - | Integrative Medical Of Dfw Llc 670 N Macarthur Blvd Ste 100 Coppell TX 75019-2733 Ph: (972) 745-4446 |
| NPI Number | 1760010201 |
|---|---|
| Provider Enumeration Date | 03/30/2020 |
| Last Update Date | 07/20/2022 |
| Medicare PECOS PAC ID | 8628451911 |
|---|---|
| Medicare Enrollment ID | O20220819000184 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760010201 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Secondary |
| Provider Name | Matthew Bruce Roberson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871590570 PECOS PAC ID: 8426158965 Enrollment ID: I20070712000313 |
| Provider Name | Derek Dustin Frye |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1497060081 PECOS PAC ID: 5799906574 Enrollment ID: I20141112002521 |
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