Healthcare Provider Details

I. General information

NPI: 1134163900
Provider Name (Legal Business Name): INTEGRIS BAPTIST MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 NW 56TH ST C100
OKLAHOMA CITY OK
73112-4550
US

IV. Provider business mailing address

PO BOX 960217
OKLAHOMA CITY OK
73196-0001
US

V. Phone/Fax

Practice location:
  • Phone: 405-945-0045
  • Fax: 405-948-6507
Mailing address:
  • Phone: 405-947-8586
  • Fax: 405-948-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KARL BOATMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 405-945-0045