Provider Demographics
NPI:1497402531
Name:INTEGRITY PRIMARY MED LLC
Entity Type:Organization
Organization Name:INTEGRITY PRIMARY MED LLC
Other - Org Name:INTEGRITY PRIMARY MED
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO / OWNER / MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CALLAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-215-3500
Mailing Address - Street 1:10491 6 MILE CYPRESS PKWY STE 271
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-6518
Mailing Address - Country:US
Mailing Address - Phone:239-215-3500
Mailing Address - Fax:239-215-3525
Practice Address - Street 1:10491 6 MILE CYPRESS PKWY STE 271
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-6518
Practice Address - Country:US
Practice Address - Phone:239-215-3500
Practice Address - Fax:239-215-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114316000Medicaid
FLXGZN9OtherBLUE CROSS - BLUE SHIELD