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General NPI Number Information
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NPI Number | 1528830163
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Entity Type | Organization
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Legal Business Name | INTEGRIS HEALTH PONCA CITY HOSPITAL INC
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 1908 N 14TH ST STE 202, 203 & 207
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City | PONCA CITY
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State | OK
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Zip | 74601-2039
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Country | US
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Telephone | 580-718-4501
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 QUAIL SPRINGS PKWY FL 3
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-2640
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Country | US
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Telephone | 405-252-8400
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Fax |
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Authorized Official
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Title or Position | ASSISTANT TREASURER
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Name | DONNA WALLACE
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Credential |
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Telephone | 636-359-4890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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