Provider Demographics
| NPI: | 1356491054 |
|---|---|
| Name: | INTEGRITY ORTHOPAEDICS SPORTS MEDICINE AND REHABILITATION PLLC |
| Entity Type: | Organization |
| Organization Name: | INTEGRITY ORTHOPAEDICS SPORTS MEDICINE AND REHABILITATION PLLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | MD/PARTNER |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | ANUP |
| Authorized Official - Middle Name: | S |
| Authorized Official - Last Name: | CHATTHA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 859-497-4144 |
| Mailing Address - Street 1: | 624 NORTH MAYSVILLE ROAD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MT STERLING |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 40353-9767 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 859-497-4144 |
| Mailing Address - Fax: | 859-498-4137 |
| Practice Address - Street 1: | 624 MAYSVILLE RD |
| Practice Address - Street 2: | |
| Practice Address - City: | MT STERLING |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 40353-9767 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 859-497-4144 |
| Practice Address - Fax: | 859-498-4137 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-01-12 |
| Last Update Date: | 2014-11-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 207X00000X, 207XS0114X, 207XX0005X, 213E00000X, 213EP1101X, 213ES0103X, 213ES0131X, 2251X0800X, 332B00000X, 363A00000X, 363AM0700X, 363AS0400X | ||
| KY | PA676 | 363A00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Single Specialty |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Single Specialty | |
| No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | Group - Single Specialty |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Single Specialty | |
| No | 213EP1101X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | Group - Single Specialty |
| No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Single Specialty |
| No | 213ES0131X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | Group - Single Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Single Specialty |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Single Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Single Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Single Specialty |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Single Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 7100266910 | Medicaid | |
| KY | 7890311900 | Medicaid | |
| KY | 7100247490 | Medicaid | |
| KY | 7100259100 | Medicaid | |
| KY | 7100247400 | Medicaid | |
| KY | 7100276930 | Medicaid | |
| KY | 7100309390 | Medicaid | |
| KY | 65939712 | Medicaid | |
| KY | 7100257060 | Medicaid | |
| KY | 7100258340 | Medicaid | |
| KY | 7100309930 | Medicaid | |
| KY | 7890311900 | Medicaid | |
| KY | 7100258340 | Medicaid |
