Healthcare Provider Details

I. General information

NPI: 1023381381
Provider Name (Legal Business Name): INTEGRITY MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2384 PETERSBURG RD
HEBRON KY
41048-9557
US

IV. Provider business mailing address

PO BOX 228
HEBRON KY
41048-0228
US

V. Phone/Fax

Practice location:
  • Phone: 859-801-9049
  • Fax: 859-689-1188
Mailing address:
  • Phone: 859-801-9049
  • Fax: 859-689-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MARQUEL F TIPTON
Title or Position: OWNER
Credential: PA
Phone: 859-801-9049