Healthcare Provider Details

I. General information

NPI: 1194748319
Provider Name (Legal Business Name): INTEGRIS MIAMI HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 2ND AVE SW
MIAMI OK
74354-6818
US

IV. Provider business mailing address

PO BOX 200759
DALLAS TX
75320-0759
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-2577
  • Fax:
Mailing address:
  • Phone: 405-252-8319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DONNA WALLACE
Title or Position: ASSISTANT TREASURER
Credential:
Phone: 636-359-4890