Healthcare Provider Details

I. General information

NPI: 1700409687
Provider Name (Legal Business Name): INTEGRITY MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13603 W CAMINO DEL SOL STE E
SUN CITY WEST AZ
85375-4483
US

IV. Provider business mailing address

13603 W CAMINO DEL SOL STE E
SUN CITY WEST AZ
85375-4483
US

V. Phone/Fax

Practice location:
  • Phone: 219-256-9750
  • Fax:
Mailing address:
  • Phone: 623-777-3347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DERICK STAGGERS
Title or Position: PRESIDENT
Credential:
Phone: 219-256-9750