Basic Information
| Provider Information | |||||||||
| NPI: | 1225345788 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST HEALTHCARE OF OKLAHOMA INC | ||||||||
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| OtherOrganizationName: | INTEGRIS SPECIALITY PHYSICIANS GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 960413 | ||||||||
| Address2: | |||||||||
| City: | OKC | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731960413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5805481367 | ||||||||
| FaxNumber: | 5805481583 | ||||||||
| Practice Location | |||||||||
| Address1: | 4221 S WESTERN AVE | ||||||||
| Address2: | SUITE 5045 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056445185 | ||||||||
| FaxNumber: | 4056445184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2010 | ||||||||
| LastUpdateDate: | 11/24/2010 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | VP INTEGRIS PHYSICIAN PRACTICE MGMT | ||||||||
| AuthorizedOfficialTelephone: | 5805481367 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 4819 | OK | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.