Provider Demographics
NPI:1114432507
Name:INTEGRIS AMBULATORY CARE CORPORATION
Entity Type:Organization
Organization Name:INTEGRIS AMBULATORY CARE CORPORATION
Other - Org Name:THE CLINIC AT HOBBY LOBBY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT & COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-949-3400
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7301 SW 44TH ST STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73179-4309
Practice Address - Country:US
Practice Address - Phone:405-357-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRIS AMBULATORY CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty