Healthcare Provider Details

I. General information

NPI: 1336155779
Provider Name (Legal Business Name): INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S DOUGLAS AVE
OKLAHOMA CITY OK
73109-3210
US

IV. Provider business mailing address

5400 N INDEPENDENCE AVE 100
OKLAHOMA CITY OK
73112-5300
US

V. Phone/Fax

Practice location:
  • Phone: 405-636-7480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number2289
License Number StateOK

VIII. Authorized Official

Name: STANELY HUPFELD
Title or Position: PRESIDENT/CEO
Credential:
Phone: 405-949-6066