Provider Demographics
NPI:1265848691
Name:INTEGRATED ORTHO, LLC
Entity Type:Organization
Organization Name:INTEGRATED ORTHO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-398-9540
Mailing Address - Street 1:970 W BROADWAY
Mailing Address - Street 2:PO BOX 30,0002 #408
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-9475
Mailing Address - Country:US
Mailing Address - Phone:877-398-9540
Mailing Address - Fax:307-460-7020
Practice Address - Street 1:970 W BROADWAY
Practice Address - Street 2:408
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-9475
Practice Address - Country:US
Practice Address - Phone:877-398-9540
Practice Address - Fax:307-460-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies