Provider Demographics
NPI:1760262539
Name:INTEGRITY ADVANCED MEDICAL
Entity Type:Organization
Organization Name:INTEGRITY ADVANCED MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHENITA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-218-9906
Mailing Address - Street 1:17407 W BLUE SKY DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-1151
Mailing Address - Country:US
Mailing Address - Phone:219-218-9906
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:623-584-1726
Practice Address - Fax:623-466-6718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty