Healthcare Provider Details

I. General information

NPI: 1336252717
Provider Name (Legal Business Name): INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 S WESTERN AVE
OKLAHOMA CITY OK
73109-3413
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 405-644-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number2289
License Number StateOK

VIII. Authorized Official

Name: CHRIS HAMMES
Title or Position: CFO
Credential:
Phone: 405-949-3402