Healthcare Provider Details

I. General information

NPI: 1013999580
Provider Name (Legal Business Name): INTEG HEALTH SYSTEM, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 02/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W 2ND ST
BLOOMINGTON IN
47403-2216
US

IV. Provider business mailing address

1011 W 2ND ST
BLOOMINGTON IN
47403-2216
US

V. Phone/Fax

Practice location:
  • Phone: 812-334-1213
  • Fax: 812-333-5039
Mailing address:
  • Phone: 812-334-1213
  • Fax: 812-333-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number50003177A
License Number StateIN

VIII. Authorized Official

Name: REX DANIEL GROSSMAN
Title or Position: PRESIDENT, SECRETARY, & TREASURER
Credential: M.D.
Phone: 812-334-1213