Provider Demographics
NPI:1164751582
Name:INTEGRA SPECIALTY GROUP, PA
Entity Type:Organization
Organization Name:INTEGRA SPECIALTY GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLOANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-263-2424
Mailing Address - Street 1:517 N CARRIER PKWY STE G
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5464
Mailing Address - Country:US
Mailing Address - Phone:972-263-2424
Mailing Address - Fax:972-263-5545
Practice Address - Street 1:517 N CARRIER PKWY STE G
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5464
Practice Address - Country:US
Practice Address - Phone:972-263-2424
Practice Address - Fax:972-263-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)