Provider Demographics
NPI: | 1306157573 |
---|---|
Name: | INTEGRITY MEDICAL GROUP, CORP |
Entity type: | Organization |
Organization Name: | INTEGRITY MEDICAL GROUP, CORP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | JESLEEN |
Authorized Official - Middle Name: | MARIE |
Authorized Official - Last Name: | VEGA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MBA |
Authorized Official - Phone: | 787-452-5504 |
Mailing Address - Street 1: | PO BOX 2438 |
Mailing Address - Street 2: | |
Mailing Address - City: | ISABELA |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00662-9438 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-452-5504 |
Mailing Address - Fax: | 787-872-8162 |
Practice Address - Street 1: | CARR 474 ESTANCIAS PARAISO #110 |
Practice Address - Street 2: | |
Practice Address - City: | ISABELA |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00662 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-452-5504 |
Practice Address - Fax: | 787-872-8162 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-06-23 |
Last Update Date: | 2010-06-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PR | 171W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171W00000X | Other Service Providers | Contractor | Group - Multi-Specialty |