Provider Demographics
NPI:1073847661
Name:INTEGRITY ONCOLOGY FOUNDATION
Entity Type:Organization
Organization Name:INTEGRITY ONCOLOGY FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBAJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-853-6012
Mailing Address - Street 1:PO BOX 5138
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-5138
Mailing Address - Country:US
Mailing Address - Phone:901-853-6012
Mailing Address - Fax:901-853-6069
Practice Address - Street 1:302 S RHODES ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4215
Practice Address - Country:US
Practice Address - Phone:870-733-1800
Practice Address - Fax:870-733-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN019652174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1548268592OtherMD NPI
AR5G397OtherPTAN