=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245469824
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRITY PROSTHETICS AND ORTHOTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2009
-----------------------------------------------------
Last Update Date | 05/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2606 LAKELAND HILLS BLVD
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33805-2218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-937-9200
-----------------------------------------------------
Fax | 863-937-9199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2606 LAKELAND HILLS BLVD
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33805-2218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-937-9200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CPO LP
-----------------------------------------------------
Name | MR. CLARENCE EDWARD CROWE II
-----------------------------------------------------
Credential | CPO
-----------------------------------------------------
Telephone | 863-581-5833
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | PRO60
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------