Provider Demographics
NPI:1134723919
Name:INTEGRA HEALTHCARE ASSOCIATES
Entity type:Organization
Organization Name:INTEGRA HEALTHCARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:GATTERDAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-271-8962
Mailing Address - Street 1:4108 CLEARWATER WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6000
Mailing Address - Country:US
Mailing Address - Phone:859-396-3050
Mailing Address - Fax:
Practice Address - Street 1:4071 TATES CREEK CENTRE DR STE 101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3063
Practice Address - Country:US
Practice Address - Phone:859-396-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty