| Integrated Infectious Diseases, PLLC | |
|
1002 Texas Blvd Ste 200 Texarkana TX 75501-5133 | |
| (903) 310-4950 | |
| Not Available |
| Full Name | Integrated Infectious Diseases, PLLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 1002 Texas Blvd Ste 200, Texarkana, Texas |
| Authorized Official Name and Position | Charles C Mbonu (PRESIDENT) |
| Authorized Official Contact | 9036145050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Infectious Diseases, PLLC Po Box 7707 Texarkana TX 75505-7707 Ph: (903) 310-4950 | Integrated Infectious Diseases, PLLC 1002 Texas Blvd Ste 200 Texarkana TX 75501-5133 Ph: (903) 310-4950 |
| NPI Number | 1376773168 |
|---|---|
| Provider Enumeration Date | 07/15/2009 |
| Last Update Date | 08/26/2026 |
| Certification Date | 08/26/2026 |
| Medicare PECOS PAC ID | 3274687355 |
|---|---|
| Medicare Enrollment ID | O20090825000292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376773168 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | () | Primary |
| Provider Name | Charles Mbonu |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1033187299 PECOS PAC ID: 6204824741 Enrollment ID: I20090825000280 |
| Provider Name | Cody Ray Copeland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689319675 PECOS PAC ID: 0648656819 Enrollment ID: I20220927000139 |
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