1568988152 NPI number — INTEGRO HEALTH SYSTEMS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568988152 NPI number — INTEGRO HEALTH SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRO HEALTH SYSTEMS, INC.
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:
6
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:
1568988152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 E ORANGEWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85020-5130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-535-8200
Provider Business Mailing Address Fax Number:
602-457-2517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 E ORANGEWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85020-5130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-535-8200
Provider Business Practice Location Address Fax Number:
602-457-2517
Provider Enumeration Date:
08/16/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CANULLA
Authorized Official First Name:
MARCO
Authorized Official Middle Name:
VALERIO
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
602-571-6521

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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