Provider Demographics
NPI:1962548602
Name:INTEGRITY MEDICAL SUPPLY ETC
Entity type:Organization
Organization Name:INTEGRITY MEDICAL SUPPLY ETC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ASSUMPTA
Authorized Official - Middle Name:SUNDAY
Authorized Official - Last Name:ETUKUDO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-I
Authorized Official - Phone:713-278-8870
Mailing Address - Street 1:PO BOX 741226
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77274-1226
Mailing Address - Country:US
Mailing Address - Phone:832-563-5889
Mailing Address - Fax:281-575-0153
Practice Address - Street 1:6300 HILLCROFT ST
Practice Address - Street 2:200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-3006
Practice Address - Country:US
Practice Address - Phone:713-278-8870
Practice Address - Fax:713-278-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3504-3505261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175737901Medicaid