1871785642 NPI number — INTEGRIS GROVE HOSPITAL

Table of content: (NPI 1871785642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871785642 NPI number — INTEGRIS GROVE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRIS GROVE HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRINITY LIFE CARE HOME HEALTH SUPPLIES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871785642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 450458
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROVE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74345-0458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1103 E 13TH STREET
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
GROVE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74344-5304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-787-3800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAWRENCE
Authorized Official First Name:
CARL
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
405-949-3177

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7012 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100699700L , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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