Provider Demographics
NPI:1912392176
Name:INTEGRITAS LLC
Entity Type:Organization
Organization Name:INTEGRITAS LLC
Other - Org Name:DIRECT CARE CLINIC OF NORTHWEST ARKANSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-268-4504
Mailing Address - Street 1:2103 S 54TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8169
Mailing Address - Country:US
Mailing Address - Phone:479-268-4504
Mailing Address - Fax:479-268-5279
Practice Address - Street 1:2103 S 54TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8169
Practice Address - Country:US
Practice Address - Phone:479-268-4504
Practice Address - Fax:479-268-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty