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General NPI Number Information
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NPI Number | 1962403030
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Entity Type | Organization
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Legal Business Name | INTEGRIS RURAL HEALTH INC
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 01/02/2012
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Provider Practice Location Address
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Address Line | 1468 N MUSTANG RD
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City | MUSTANG
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State | OK
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Zip | 73064-0000
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Country | US
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Telephone | 405-376-1800
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Fax | 405-376-1856
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Provider Business Mailing Address
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Address Line | PO BOX 960033
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City | OKLAHOMA CITY
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State | OK
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Zip | 73196-0033
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Country | US
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Telephone | 580-548-1367
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Fax | 580-548-1583
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Authorized Official
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Title or Position | VP OF PHYSICIAN PRACTICE MANAGEMENT
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Name | JEFFREY M BROWN
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Credential |
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Telephone | 580-548-1367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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