Healthcare Provider Details

I. General information

NPI: 1528060019
Provider Name (Legal Business Name): INTEGRIS BASS BAPTIST HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MAIN ST PO BX 659
GARBER OK
73738-0659
US

IV. Provider business mailing address

PO BOX 5038
ENID OK
73702-5038
US

V. Phone/Fax

Practice location:
  • Phone: 580-863-2204
  • Fax: 580-863-5309
Mailing address:
  • Phone: 580-548-1367
  • Fax: 580-548-1537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GREG A MEYERS
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 580-977-1831