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General NPI Number Information
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NPI Number | 1790141935
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Entity Type | Organization
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Legal Business Name | INTEGRIS AMBULATORY CARE CORP
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 5520 N INDEPENDENCE AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-5641
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Country | US
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Telephone | 405-949-3891
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Fax | 405-949-3475
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Provider Business Mailing Address
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Address Line | 5520 N INDEPENDENCE AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-5641
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Country | US
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Telephone | 405-949-3891
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Fax | 405-949-3475
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | C BRUCE LAWRENCE
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Credential |
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Telephone | 405-949-3177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number | 2297
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License Number State | OK
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