Healthcare Provider Details

I. General information

NPI: 1205969458
Provider Name (Legal Business Name): INTEGRIS BAPTIST ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPRESSWAY ST
OKLAHOMA CITY OK
73112-4418
US

IV. Provider business mailing address

3300 NW EXPRESSWAY ST
OKLAHOMA CITY OK
73112-4418
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-3011
  • Fax:
Mailing address:
  • Phone: 405-949-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STANLEY F HUPFELD
Title or Position: CEO
Credential:
Phone: 405-949-3011