Healthcare Provider Details

I. General information

NPI: 1760262539
Provider Name (Legal Business Name): INTEGRITY ADVANCED MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/29/2023
Certification Date: 09/27/2023
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

17407 W BLUE SKY DR
SURPRISE AZ
85387-1151
US

V. Phone/Fax

Practice location:
  • Phone: 623-584-1726
  • Fax: 623-466-6718
Mailing address:
  • Phone: 219-218-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHENITA STAGGERS
Title or Position: VICE PRESIDENT
Credential: DC
Phone: 219-218-9906