Basic Information
| Provider Information | |||||||||
| NPI: | 1912598327 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRIS DDSI ENDOSCOPY CENTERS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5400 N INDEPENDENCE AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731125300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057135506 | ||||||||
| FaxNumber: | 4057137582 | ||||||||
| Practice Location | |||||||||
| Address1: | 3366 NW EXPRESSWAY STE 400 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731124416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057021300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2021 | ||||||||
| LastUpdateDate: | 01/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | WEED | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4059512757 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.