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General NPI Number Information
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NPI Number | 1790128817
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Entity Type | Organization
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Legal Business Name | INTEGRITAS EMERGENCY PHYSICIAN SERVICES, LLC
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 2250 N. ILLINOIS AVE
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City | CARBONDALE
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State | IL
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Zip | 62901
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Country | US
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Telephone | 618-833-1691
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Fax | 618-861-5302
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Provider Business Mailing Address
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Address Line | 2250 N. ILLINOIS AVE
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City | CARBONDALE
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State | IL
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Zip | 62901
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Country | US
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Telephone | 618-833-1691
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Fax | 618-861-5302
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Authorized Official
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Title or Position | BUSINESS OPERATIONS MANAGER
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Name | CALEB SUTTON
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Credential |
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Telephone | 618-833-1691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036091188
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License Number State | IL
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