Healthcare Provider Details

I. General information

NPI: 1962403030
Provider Name (Legal Business Name): INTEGRIS RURAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 N MUSTANG RD
MUSTANG OK
73064-0000
US

IV. Provider business mailing address

PO BOX 960033
OKLAHOMA CITY OK
73196-0033
US

V. Phone/Fax

Practice location:
  • Phone: 405-376-1800
  • Fax: 405-376-1856
Mailing address:
  • Phone: 580-548-1367
  • Fax: 580-548-1583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY M BROWN
Title or Position: VP OF PHYSICIAN PRACTICE MANAGEMENT
Credential:
Phone: 580-548-1367