1215121702 NPI number — INTEGRITY HEALTH CARE SERVICES LLC

Table of content: MR. RICHARD P. CLAFFEY HEARING AID FITTER (NPI 1760508816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215121702 NPI number — INTEGRITY HEALTH CARE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRITY HEALTH CARE SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215121702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1013 111TH AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAINE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55434-4519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1013 111TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAINE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55434-4519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-245-3642
Provider Business Practice Location Address Fax Number:
763-862-7438
Provider Enumeration Date:
08/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MUMBA
Authorized Official First Name:
ENID
Authorized Official Middle Name:
Authorized Official Title or Position:
ADIMISTRATOR
Authorized Official Telephone Number:
763-245-3643

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  337591 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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