1093239469 NPI number — INTEGRITY EXTENDED HEALTHCARE LLC

Table of content: (NPI 1093239469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093239469 NPI number — INTEGRITY EXTENDED HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRITY EXTENDED HEALTHCARE 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:
1093239469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUBANK
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42567-0010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-660-5830
Provider Business Mailing Address Fax Number:
859-224-2057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 W MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40444-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-660-5830
Provider Business Practice Location Address Fax Number:
859-224-2057
Provider Enumeration Date:
07/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
RAVI
Authorized Official First Name:
PALLAKI
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
248-660-5830

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  46290 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MPKY.0674-00 . This is a "MED MAL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com