Healthcare Provider Details

I. General information

NPI: 1013256320
Provider Name (Legal Business Name): INTEGRA PARTNERS IPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 W. BIG BEAVER RD. STE. 211
TROY MI
48084-2811
US

IV. Provider business mailing address

P.O. BOX 81580
ROCHESTER MI
48308
US

V. Phone/Fax

Practice location:
  • Phone: 718-369-0012
  • Fax: 718-287-1229
Mailing address:
  • Phone: 718-369-0012
  • Fax: 718-287-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: LAUREN RUSSO
Title or Position: GENERAL COUNSEL
Credential:
Phone: 718-819-3920