Basic Information
| Provider Information | |||||||||
| NPI: | 1184909384 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTEGRITY ONCOLOGY FOUNDATION, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INTEGRITY ONCOLOGY, PLLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1000 DEPT 0170 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018536012 | ||||||||
| FaxNumber: | 9018547630 | ||||||||
| Practice Location | |||||||||
| Address1: | 1936 W POPLAR AVE | ||||||||
| Address2: | |||||||||
| City: | COLLIERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380170605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018536012 | ||||||||
| FaxNumber: | 9018547630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2011 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | OBAJI | ||||||||
| AuthorizedOfficialFirstName: | ROLA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9018536012 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.