Healthcare Provider Details

I. General information

NPI: 1114931342
Provider Name (Legal Business Name): INTEGRIS MIAMI HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 2ND AVE SW
MIAMI OK
74354-6830
US

IV. Provider business mailing address

5400 N INDEPENDENCE AVE SUITE 100
OKLAHOMA CITY OK
73112-5310
US

V. Phone/Fax

Practice location:
  • Phone: 918-542-6611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2193
License Number StateOK

VIII. Authorized Official

Name: DONNA MARIE WALLACE
Title or Position: VP FINANCE
Credential:
Phone: 636-359-4890