Basic Information
| Provider Information | |||||||||
| NPI: | 1679070577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRIS BASS BAPTIST HEALTH CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INTEGRIS BASS SPECIALTY-GASTROENTEROLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 269032 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731269032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052528400 | ||||||||
| FaxNumber: | 4057134322 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 S MONROE ST | ||||||||
| Address2: | |||||||||
| City: | ENID | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737017286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809771960 | ||||||||
| FaxNumber: | 5809771959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2018 | ||||||||
| LastUpdateDate: | 04/09/2018 | ||||||||
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| AuthorizedOfficialLastName: | HAMMES | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT & COO | ||||||||
| AuthorizedOfficialTelephone: | 4059493402 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INTEGRIS BASS BAPTIST HEALTH CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.