Healthcare Provider Details

I. General information

NPI: 1174509699
Provider Name (Legal Business Name): INTEGRIS RURAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S MONROE ST
ENID OK
73701-7286
US

IV. Provider business mailing address

PO BOX 960097
OKLAHOMA CITY OK
73196-0097
US

V. Phone/Fax

Practice location:
  • Phone: 580-616-7634
  • Fax: 580-237-7516
Mailing address:
  • Phone: 580-548-1367
  • Fax: 580-548-1583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY M BROWN
Title or Position: VP REGIONAL PHYSICIAN PRACTICE MGMT
Credential:
Phone: 580-548-1367