Provider Demographics
NPI:1780963330
Name:INTEGRIS BAPTIST MEDICAL CENTER INC
Entity type:Organization
Organization Name:INTEGRIS BAPTIST MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V P INTEGRITY REVENUE
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-949-3774
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:STE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-951-8671
Mailing Address - Fax:405-553-5682
Practice Address - Street 1:5100 N BROOKLINE AVE
Practice Address - Street 2:STE 950
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3623
Practice Address - Country:US
Practice Address - Phone:405-717-9800
Practice Address - Fax:405-942-4790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRIS BAPTIST MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-15
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100806400FMedicaid