MEDICARE: INTEGRIS BAPTIST MEDICAL CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	7193	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174542195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRIS BAPTIST MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 268907
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73196-8907
Country	:	US
Telephone Number	:	405-951-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 NW 56TH ST
Second Line	:	201
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4517
Country	:	US
Telephone Number	:	405-951-8400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	C BRUCE LAWRENCE
Credential	:
Telephone Number	:	405-949-6066

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/12/2016

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