Healthcare Provider Details

I. General information

NPI: 1053327486
Provider Name (Legal Business Name): BASS MEMORIAL BAPTIST HOSPITAL DBA INTEGRIS BASS BAPTIST HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 E GARRIOTT RD SUITE D
ENID OK
73701-6156
US

IV. Provider business mailing address

PO BOX 5038
ENID OK
73702-5038
US

V. Phone/Fax

Practice location:
  • Phone: 580-234-8998
  • Fax: 580-234-8465
Mailing address:
  • Phone: 580-548-1367
  • Fax: 580-548-1583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARL B. LAWRENCE
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 405-951-2616