MEDICARE: INTEGRIS RURAL HEALTH 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	208000000X	Pediatrics Physician
2	207Q00000X	Family Medicine Physician

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962403030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRIS RURAL HEALTH INC

Provider Business Mailing Address
First Line	:	PO BOX 960033
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73196-0033
Country	:	US
Telephone Number	:	580-548-1367
Fax Number	:	580-548-1583

Provider Business Practice Location Address
First Line	:	1468 N MUSTANG RD
Second Line	:
City	:	MUSTANG
State	:	OK
Zip	:	73064-0000
Country	:	US
Telephone Number	:	405-376-1800
Fax Number	:	405-376-1856

Authorized Official
Title or Position	:	VP OF PHYSICIAN PRACTICE MANAGEMENT
Name	:	JEFFREY M BROWN
Credential	:
Telephone Number	:	580-548-1367

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	01/02/2012

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