Provider Demographics
NPI:1992167910
Name:INTEGRITY HEALTH CENTER, LLC
Entity type:Organization
Organization Name:INTEGRITY HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNIGGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-492-9170
Mailing Address - Street 1:3901 NW 79TH AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3901 NW 79TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6508
Practice Address - Country:US
Practice Address - Phone:305-492-9170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
FLME69741207Q00000X
FLME125615208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty