Provider Demographics
NPI:1184909384
Name:INTEGRITY ONCOLOGY FOUNDATION, INC.
Entity type:Organization
Organization Name:INTEGRITY ONCOLOGY FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBAJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-853-6012
Mailing Address - Street 1:PO BOX 1000 DEPT 0170
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0170
Mailing Address - Country:US
Mailing Address - Phone:901-853-6012
Mailing Address - Fax:901-854-7630
Practice Address - Street 1:1936 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0605
Practice Address - Country:US
Practice Address - Phone:901-853-6012
Practice Address - Fax:901-854-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10370G0697Medicare PIN