Provider Demographics
NPI:1962901553
Name:INTEGRITY MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:INTEGRITY MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:863-268-7984
Mailing Address - Street 1:817 TERRANOVA RD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3441
Mailing Address - Country:US
Mailing Address - Phone:863-268-7984
Mailing Address - Fax:863-268-7985
Practice Address - Street 1:252 AMERICAN SPIRIT RD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-8102
Practice Address - Country:US
Practice Address - Phone:863-268-7984
Practice Address - Fax:863-268-7985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL15000150993343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)