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General NPI Number Information
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NPI Number | 1518594282
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Entity Type | Organization
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Legal Business Name | INTEGRA-TELEMEDICINE
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 4108 CLEARWATER WAY
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City | LEXINGTON
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State | KY
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Zip | 40515-6000
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Country | US
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Telephone | 859-396-3050
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Fax |
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Provider Business Mailing Address
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Address Line | 4108 CLEARWATER WAY
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City | LEXINGTON
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State | KY
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Zip | 40515-6000
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Country | US
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Telephone | 859-396-3050
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. CLAYTON P GATTERDAM IV
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Credential | PA-C
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Telephone | 859-396-3050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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