Provider Demographics
NPI:1033981675
Name:INTEGRIS HEALTH WOODWARD HOSPITAL INC
Entity Type:Organization
Organization Name:INTEGRIS HEALTH WOODWARD HOSPITAL INC
Other - Org Name:INTEGRIS HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-359-4890
Mailing Address - Street 1:3001 QUAIL SPRINGS PKWY FL 3
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2640
Mailing Address - Country:US
Mailing Address - Phone:405-252-8400
Mailing Address - Fax:
Practice Address - Street 1:1611 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3064
Practice Address - Country:US
Practice Address - Phone:580-254-8486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRIS HEALTH WOODWARD HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-26
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health