Integrative Multidisciplinary Medical Group | |
670 N Macarthur Blvd Coppell TX 75019-2733 | |
(972) 745-4446 | |
(972) 745-2597 |
Full Name | Integrative Multidisciplinary Medical Group |
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Speciality | Internal Medicine |
Location | 670 N Macarthur Blvd, Coppell, Texas |
Authorized Official Name and Position | John W East (OWNER) |
Authorized Official Contact | 2147227102 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Integrative Multidisciplinary Medical Group 670 N Macarthur Blvd Coppell TX 75019-2733 Ph: (972) 745-4446 | Integrative Multidisciplinary Medical Group 670 N Macarthur Blvd Coppell TX 75019-2733 Ph: (972) 745-4446 |
NPI Number | 1124554746 |
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Provider Enumeration Date | 05/02/2017 |
Last Update Date | 10/13/2017 |
Medicare PECOS PAC ID | 6305104548 |
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Medicare Enrollment ID | O20171218001711 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124554746 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | P8718 (Texas) | Primary |
Provider Name | Matthew Bruce Roberson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1871590570 PECOS PAC ID: 8426158965 Enrollment ID: I20070712000313 |
Provider Name | Derek Dustin Frye |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1497060081 PECOS PAC ID: 5799906574 Enrollment ID: I20141112002521 |
Provider Name | Rachel Lisle |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457826596 PECOS PAC ID: 6103153192 Enrollment ID: I20190814001297 |
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