Healthcare Provider Details

I. General information

NPI: 1255621173
Provider Name (Legal Business Name): INTERGRATED COMPREHENSIVE HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 NW 10TH ST SUITE B ROOM 7&8
OKLAHOMA CITY OK
73127-2974
US

IV. Provider business mailing address

8101 NW 10TH ST SUITE B ROOM 7&8
OKLAHOMA CITY OK
73127-2974
US

V. Phone/Fax

Practice location:
  • Phone: 405-495-6200
  • Fax:
Mailing address:
  • Phone: 405-495-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY HANSARD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 405-495-6200