=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750702593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRAL STAFFING AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2013
-----------------------------------------------------
Last Update Date | 12/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11903 MAIN ST UNIT 367, UNIT 14
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22408-7326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-703-3348
-----------------------------------------------------
Fax | 866-485-6394
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11903 MAIN ST UNIT 367, UNIT 14
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22408-7326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-703-3348
-----------------------------------------------------
Fax | 866-485-6394
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROBERT MCCLATCHEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 866-703-3348
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------