Provider Demographics
NPI:1831134576
Name:INTEGRA HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:INTEGRA HEALTH CENTER, LLC
Other - Org Name:INTEGRA HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MED, RKT, ATC
Authorized Official - Phone:317-823-8400
Mailing Address - Street 1:8150 OAKLANDON RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9525
Mailing Address - Country:US
Mailing Address - Phone:317-823-8400
Mailing Address - Fax:317-823-8402
Practice Address - Street 1:8150 OAKLANDON RD
Practice Address - Street 2:SUITE 111
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-9525
Practice Address - Country:US
Practice Address - Phone:317-823-8400
Practice Address - Fax:317-823-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy