Provider Demographics
NPI:1780119354
Name:INTEGRITY MEDICAL GROUP LLC
Entity type:Organization
Organization Name:INTEGRITY MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-243-1239
Mailing Address - Street 1:3900 WESTERRE PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1478
Mailing Address - Country:US
Mailing Address - Phone:804-521-5315
Mailing Address - Fax:804-477-1252
Practice Address - Street 1:5700 FITZHUGH AVE
Practice Address - Street 2:C/O HEALTHSOUTH REHABILITATION HOSPITAL
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1800
Practice Address - Country:US
Practice Address - Phone:804-521-5315
Practice Address - Fax:804-477-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty