Healthcare Provider Details

I. General information

NPI: 1619721784
Provider Name (Legal Business Name): INTEGRIS BAPTIST MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 N PORTLAND AVE
OKLAHOMA CITY OK
73112-2074
US

IV. Provider business mailing address

PO BOX 200757
DALLAS TX
75320-0757
US

V. Phone/Fax

Practice location:
  • Phone: 405-604-6000
  • Fax:
Mailing address:
  • Phone: 405-252-8319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

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