NPIMap

Organization Active NPI

Waco Integrated Medical PLLC

  • General Practice Physician
  • Woodway, TX
National Provider Identifier
1205397965
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
WACO INTEGRATED MEDICAL PLLC
Practice address
8300 Old McGregor Rd Ste 2a
Woodway, TX 76712-3600
Phone
(254) 537-1064
Fax
(254) 537-1092
NPI assigned
Mar 26, 2019
Last updated
May 26, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Philip Fulton
Title
Billing Manager
Phone
(254) 581-0247

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

8300 Old McGregor Rd Ste 2a
Woodway, TX 76712-3600

Mailing address

5000 W Waco Dr
Waco, TX 76710-7022
Phone (254) 537-1064

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190925001552 TX Part B Supplier - Clinic/Group Practice 3274863808 Receives reassigned benefits from 20 practitioners
Practice locations: Waco, TX; Hewitt, TX
O20200512000117 TX DME Supplier - Physician - General Practice 3274863808 Practice locations: Waco, TX

National Provider Directory

National Provider Directory

Locations

518 N Hewitt Dr
Ste 1
Hewitt, TX 76643
Phone (254) 899-2225

1139 N Loop 340
Waco, TX 76705
Phone (254) 799-8343

5000 W Waco Dr
Waco, TX 76710
Phone (254) 537-1064

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779753600000",
    "number": "1205397965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 W WACO DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767107022",
            "telephone_number": "254-537-1064",
            "fax_number": "254-537-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8300 OLD MCGREGOR RD STE 2A",
            "city": "WOODWAY",
            "state": "TX",
            "postal_code": "767123600",
            "telephone_number": "254-537-1064",
            "fax_number": "254-537-1092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACO INTEGRATED MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-26",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A",
        "authorized_official_last_name": "FULTON",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "254-581-0247"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodway, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.