Healthcare Provider Details

I. General information

NPI: 1003672353
Provider Name (Legal Business Name): INTEGRITY VIRTUAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N 7TH ST
STERLING KS
67579-1803
US

IV. Provider business mailing address

207 N 7TH ST
STERLING KS
67579-1803
US

V. Phone/Fax

Practice location:
  • Phone: 620-204-1170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MICAH FORMAN
Title or Position: CEO
Credential: APRN
Phone: 620-204-1170