Provider Demographics
NPI:1225175292
Name:INTEGRITY MEDICAL SUPPLY ETC
Entity Type:Organization
Organization Name:INTEGRITY MEDICAL SUPPLY ETC
Other - Org Name:INTEGRITY HEALTHCARE SUPPORTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ASSUMPTA
Authorized Official - Middle Name:SUNDAY
Authorized Official - Last Name:ETUKUDO
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:713-278-8870
Mailing Address - Street 1:PO BOX 741226
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77274-1226
Mailing Address - Country:US
Mailing Address - Phone:832-563-5889
Mailing Address - Fax:713-278-9711
Practice Address - Street 1:6630 HARWIN DR
Practice Address - Street 2:#206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2245
Practice Address - Country:US
Practice Address - Phone:832-563-5889
Practice Address - Fax:713-278-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169669202Medicaid