Provider Demographics
NPI:1366886939
Name:CLEBURNE INTEGRATED WELLNESS PA
Entity type:Organization
Organization Name:CLEBURNE INTEGRATED WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:FREELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-556-2000
Mailing Address - Street 1:821 N NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7001
Mailing Address - Country:US
Mailing Address - Phone:817-556-2000
Mailing Address - Fax:817-553-2031
Practice Address - Street 1:821 N NOLAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7001
Practice Address - Country:US
Practice Address - Phone:817-556-2000
Practice Address - Fax:817-553-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC7600332B00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303656Medicare PIN
TX6835710001Medicare NSC