Basic Information
| Provider Information | |||||||||
| NPI: | 1831142967 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST CARDIOLOGY SPECIALISTS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INTEGRID BAPTIST MEDICAL CENTER, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 96-0372 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731960372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059514360 | ||||||||
| FaxNumber: | 4059514359 | ||||||||
| Practice Location | |||||||||
| Address1: | 3433 NW 56TH ST | ||||||||
| Address2: | 400 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731124455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059514360 | ||||||||
| FaxNumber: | 4059514359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 03/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | MEYERS | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4059514360 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 200121670A | 05 | OK | MEDICAID |