1629337381 NPI number — INTEGRIS RURAL HEALTH INC.

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 1629337381 NPI number — INTEGRIS RURAL HEALTH INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRIS RURAL HEALTH INC.
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:
Provider Other Organization Name Type Code:
6
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:
1629337381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 960443
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73196-0443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-548-1367
Provider Business Mailing Address Fax Number:
580-548-1537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 E GARRIOTT RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ENID
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73701-6153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-213-9745
Provider Business Practice Location Address Fax Number:
580-234-5749
Provider Enumeration Date:
05/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CASH
Authorized Official First Name:
JORDAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
VP INTEGRIS BASS BAPTIST HEALTH CTR
Authorized Official Telephone Number:
580-548-1367

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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: 200219500F , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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