Provider Demographics
NPI:1851015127
Name:INTEGRITY DIRECT PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:INTEGRITY DIRECT PRIMARY CARE, LLC
Other - Org Name:INTEGRITY HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RICKOLL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:504-473-6943
Mailing Address - Street 1:764 WALNUT KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3113
Mailing Address - Country:US
Mailing Address - Phone:901-756-5565
Mailing Address - Fax:901-756-5564
Practice Address - Street 1:3637 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6110
Practice Address - Country:US
Practice Address - Phone:504-613-0315
Practice Address - Fax:504-613-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty