Provider Demographics
NPI:1902850373
Name:SOUTH INTEGRITY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SOUTH INTEGRITY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-242-0775
Mailing Address - Street 1:1541 SE 12TH AVE
Mailing Address - Street 2:SUITE 28
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034-2699
Mailing Address - Country:US
Mailing Address - Phone:305-242-0775
Mailing Address - Fax:
Practice Address - Street 1:1541 SE 12TH AVE
Practice Address - Street 2:SUITE 28
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33034-2699
Practice Address - Country:US
Practice Address - Phone:305-242-0775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty