Healthcare Provider Details

I. General information

NPI: 1699497016
Provider Name (Legal Business Name): INTEGRITY MEDICAL GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 BARSTOW AVE STE 19
CLOVIS CA
93612-2292
US

IV. Provider business mailing address

635 BARSTOW AVE STE 19
CLOVIS CA
93612-2292
US

V. Phone/Fax

Practice location:
  • Phone: 208-860-2849
  • Fax: 208-450-2219
Mailing address:
  • Phone: 208-860-2849
  • Fax: 208-450-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KREG J LOVE
Title or Position: OFFICER
Credential: DO
Phone: 435-553-4130