Provider Demographics
NPI:1376994129
Name:INTEGRA CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:INTEGRA CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-856-9355
Mailing Address - Street 1:6030 DAYBREAK CIR STE A150-183
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1642
Mailing Address - Country:US
Mailing Address - Phone:844-856-9355
Mailing Address - Fax:844-856-9355
Practice Address - Street 1:6030 DAYBREAK CIR STE A150-183
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1642
Practice Address - Country:US
Practice Address - Phone:844-856-9355
Practice Address - Fax:844-856-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty