Provider Demographics
NPI: | 1619712973 |
---|---|
Name: | INTEGRITY FIRST MEDCARE LLC |
Entity type: | Organization |
Organization Name: | INTEGRITY FIRST MEDCARE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KENDRICK |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MOSLEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 419-318-9669 |
Mailing Address - Street 1: | 5745 GAY ST |
Mailing Address - Street 2: | |
Mailing Address - City: | TOLEDO |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43613-1846 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5745 GAY ST |
Practice Address - Street 2: | |
Practice Address - City: | TOLEDO |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43613-1846 |
Practice Address - Country: | US |
Practice Address - Phone: | 419-318-9669 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-06-28 |
Last Update Date: | 2024-06-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 246RP1900X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Phlebotomy | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 236 | Medicaid |