Provider Demographics
NPI:1134499338
Name:INTEGRIS BASS BAPTIST HEALTH CENTER
Entity Type:Organization
Organization Name:INTEGRIS BASS BAPTIST HEALTH CENTER
Other - Org Name:PARRISH ENTERPRISES EMPLOYEE'S MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP INTEGRIS RURAL PHYS PRACTICE MGM
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-548-1367
Mailing Address - Street 1:PO BOX 5038
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-5038
Mailing Address - Country:US
Mailing Address - Phone:580-548-1367
Mailing Address - Fax:580-548-1537
Practice Address - Street 1:1414 E WILLOW RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-8714
Practice Address - Country:US
Practice Address - Phone:580-237-4033
Practice Address - Fax:580-237-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care