Provider Demographics
NPI:1295063212
Name:INTEGRAL PRIMARY CARE INC.
Entity type:Organization
Organization Name:INTEGRAL PRIMARY CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BETANCES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-386-1096
Mailing Address - Street 1:2311 10TH AVE N STE 14
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6605
Mailing Address - Country:US
Mailing Address - Phone:561-586-5326
Mailing Address - Fax:561-586-7237
Practice Address - Street 1:27 NE 1ST AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6609
Practice Address - Country:US
Practice Address - Phone:954-942-1290
Practice Address - Fax:954-942-5067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care