Healthcare Provider Details

I. General information

NPI: 1386245744
Provider Name (Legal Business Name): INTEGRIS MIAMI HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 2ND AVE SW STE 101, 102, 103, 105, 106A, 106B, 107A, 107B, & 203
MIAMI OK
74354-6743
US

IV. Provider business mailing address

5400 N INDEPENDENCE AVE STE 200
OKLAHOMA CITY OK
73112-5300
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-7700
  • Fax:
Mailing address:
  • Phone: 405-713-5515
  • Fax: 405-713-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENT HUBBARD
Title or Position: SENIOR VICE PRESIDENT & COO
Credential:
Phone: 405-949-3402