Basic Information
Provider Information | |||||||||
NPI: | 1851560759 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BAPTIST HEALTHCARE OF OKLAHOMA INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | INTEGRIS FAMILY MEDICINE OF SOUTHERN OKLAHOMA | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 960251 | ||||||||
Address2: |   | ||||||||
City: | OKLAHOMA CITY | ||||||||
State: | OK | ||||||||
PostalCode: | 731960251 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5805481367 | ||||||||
FaxNumber: | 5805481583 | ||||||||
Practice Location | |||||||||
Address1: | 2 HOSPITAL DR | ||||||||
Address2: |   | ||||||||
City: | MADILL | ||||||||
State: | OK | ||||||||
PostalCode: | 734460604 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5807950191 | ||||||||
FaxNumber: | 5807950194 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/25/2008 | ||||||||
LastUpdateDate: | 02/25/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WEINMEISTER | ||||||||
AuthorizedOfficialFirstName: | OSCAR | ||||||||
AuthorizedOfficialMiddleName: | KARL | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT RURAL HEALTH | ||||||||
AuthorizedOfficialTelephone: | 5805481367 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: | JR. | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.