Provider Demographics
NPI:1194033688
Name:INTEGRA MEDICAL SERVICES,INC.
Entity Type:Organization
Organization Name:INTEGRA MEDICAL SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:LEONG
Authorized Official - Last Name:MANGUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-934-3977
Mailing Address - Street 1:3312 W. 111TH ST.
Mailing Address - Street 2:UNIT A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2747
Mailing Address - Country:US
Mailing Address - Phone:877-437-6141
Mailing Address - Fax:866-205-6594
Practice Address - Street 1:3312 W 111TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2747
Practice Address - Country:US
Practice Address - Phone:877-437-6141
Practice Address - Fax:866-205-6594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies