1306569546 NPI number — INTEGUMED LLC

Table of content: (NPI 1306569546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306569546 NPI number — INTEGUMED LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGUMED 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:
1306569546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12315 HANCOCK ST STE 24
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-5885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-708-3732
Provider Business Mailing Address Fax Number:
888-316-7962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
194 E SOUTHWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KOKOMO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46902-3650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-485-1814
Provider Business Practice Location Address Fax Number:
765-316-7962
Provider Enumeration Date:
09/22/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PERRY
Authorized Official First Name:
KELLEE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
765-251-3987

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300076258 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com