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General NPI Number Information
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NPI Number | 1871785642
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Entity Type | Organization
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Legal Business Name | INTEGRIS GROVE HOSPITAL
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 1103 E 13TH STREET SUITE D
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City | GROVE
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State | OK
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Zip | 74344-5304
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Country | US
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Telephone | 918-787-3800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 450458
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City | GROVE
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State | OK
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Zip | 74345-0458
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | CARL 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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 7012
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License Number State | OK
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