Healthcare Provider Details

I. General information

NPI: 1396216677
Provider Name (Legal Business Name): INTEGRIS BASS BAPTIST HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 12/11/2018
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 269032
OKLAHOMA CITY OK
73126-9032
US

V. Phone/Fax

Practice location:
  • Phone: 580-977-1960
  • Fax: 580-977-1959
Mailing address:
  • Phone: 405-252-8400
  • Fax: 405-713-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENT DAVIS
Title or Position: VICE PRESIDENT
Credential:
Phone: 405-949-3774