Provider Demographics
NPI:1700409687
Name:INTEGRITY MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:INTEGRITY MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-256-9750
Mailing Address - Street 1:13603 W CAMINO DEL SOL STE E
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4483
Mailing Address - Country:US
Mailing Address - Phone:623-777-3347
Mailing Address - Fax:
Practice Address - Street 1:13603 W CAMINO DEL SOL STE E
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4483
Practice Address - Country:US
Practice Address - Phone:219-256-9750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment