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General NPI Number Information
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NPI Number | 1346645330
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Entity Type | Organization
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Legal Business Name | INTEGRA LAB MANAGEMENT LLC
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 09/28/2015
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Provider Practice Location Address
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Address Line | 1001 JUPITER PARK DRIVE, # 117
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City | JUPITER
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State | FL
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Zip | 33458
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Country | US
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Telephone | 561-935-3035
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Fax | 561-935-3036
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Provider Business Mailing Address
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Address Line | 1001 JUPITER PARK DR #117
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City | JUPITER
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State | FL
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Zip | 33458-6002
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Country | US
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Telephone | 561-935-3035
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Fax | 561-935-3036
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Authorized Official
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Title or Position | CEO
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Name | THOMAS HUGHES
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Credential |
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Telephone | 561-935-3035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 10D2089972
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License Number State | FL
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