Provider Demographics
NPI:1902177629
Name:INTEGRITY PROSTHETICS AND ORTHOTICS
Entity Type:Organization
Organization Name:INTEGRITY PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CROWE
Authorized Official - Suffix:II
Authorized Official - Credentials:CPO, LP
Authorized Official - Phone:863-937-9200
Mailing Address - Street 1:12206 BRUCE B DOWNS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9211
Mailing Address - Country:US
Mailing Address - Phone:813-416-5905
Mailing Address - Fax:
Practice Address - Street 1:12206 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9211
Practice Address - Country:US
Practice Address - Phone:813-416-5905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPRO125335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001376200Medicaid
FL6266600001Medicare NSC