Healthcare Provider Details

I. General information

NPI: 1134148125
Provider Name (Legal Business Name): INTEGRIS EXTENDED CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 S WESTERN AVE 7TH FLOOR
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: 405-636-7000
  • Fax:
Mailing address:
  • Phone: 405-949-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2348
License Number StateOK

VIII. Authorized Official

Name: MR. STANLEY F HUPFELD
Title or Position: PRESIDENT/CEO
Credential:
Phone: 405-949-6066