1902913999 NPI number — INTEGRIS BASS BAPTIST HEALTH CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902913999 NPI number — INTEGRIS BASS BAPTIST HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRIS BASS BAPTIST HEALTH CENTER
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:
INTEGRIS BASS BAPTIST HLTH CTR GENERATIONS GEROPSYCH UNIT
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:
1902913999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5400 N. INDEPENDENCE
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73112-5300
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:
600 S MONROE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENID
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73701-7211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-233-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAWRENCE
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
405-949-6066

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  2244 , 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: 100699500R , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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