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NPI Code Detail

MEDICARE: INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION

MEDICARE: INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0206XMammography Clinic/Center2289OK

General Provider Information

NPI Number : 1336155779
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION
Provider Business Mailing Address
First Line : 5400 N INDEPENDENCE AVE
Second Line : 100
City : OKLAHOMA CITY
State : OK
Zip : 73112-5300
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4100 S DOUGLAS AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73109-3210
Country : US
Telephone Number : 405-636-7480
Fax Number :
Authorized Official
Title or Position : PRESIDENT/CEO
Name : STANELY HUPFELD
Credential :
Telephone Number : 405-949-6066
Provider Enumeration Date : 07/31/2006
Last Update Date : 05/11/2010

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Practice Location Address:
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1184885139 — MRS. TIFFANY LEE REA M.S. CCC-SLP
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1861654592 — MR. JOSEPH POWERS PTA
Practice Location Address:
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