1356491054 NPI number — INTEGRITY ORTHOPAEDICS SPORTS MEDICINE AND REHABILITATION PLLC

Table of content: (NPI 1356491054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356491054 NPI number — INTEGRITY ORTHOPAEDICS SPORTS MEDICINE AND REHABILITATION PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRITY ORTHOPAEDICS SPORTS MEDICINE AND REHABILITATION PLLC
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:
1356491054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
624 NORTH MAYSVILLE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT STERLING
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40353-9767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-497-4144
Provider Business Mailing Address Fax Number:
859-498-4137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
624 MAYSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT STERLING
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40353-9767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-497-4144
Provider Business Practice Location Address Fax Number:
859-498-4137
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHATTHA
Authorized Official First Name:
ANUP
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MD/PARTNER
Authorized Official Telephone Number:
859-497-4144

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0114X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213EP1101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA676 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100266910 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7890311900 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100247490 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100259100 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100247400 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100276930 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100309390 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65939712 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100257060 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100258340 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100309930 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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