Basic Information
| Provider Information | |||||||||
| NPI: | 1356580997 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTEGRIS SOUTHWEST MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2604 SW 91ST ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731596708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056367000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2604 SW 91ST ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731596708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053782209 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2009 | ||||||||
| LastUpdateDate: | 02/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | COPLEY | ||||||||
| AuthorizedOfficialFirstName: | VALLIE | ||||||||
| AuthorizedOfficialMiddleName: | JO | ||||||||
| AuthorizedOfficialTitleorPosition: | TEAM MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4059901200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CCNS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | R0079679 | OK | Y | Hospitals | General Acute Care Hospital |
No ID Information.