Provider Demographics
NPI:1174509699
Name:INTEGRIS RURAL HEALTH INC
Entity Type:Organization
Organization Name:INTEGRIS RURAL HEALTH INC
Other - Org Name:DAVID W VANHOOSER MD CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REGIONAL PHYSICIAN PRACTICE MGMT
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 960097
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0097
Mailing Address - Country:US
Mailing Address - Phone:580-548-1367
Mailing Address - Fax:580-548-1583
Practice Address - Street 1:707 S MONROE ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7286
Practice Address - Country:US
Practice Address - Phone:580-616-7634
Practice Address - Fax:580-237-7516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200058050AMedicaid
KS200308850BMedicaid
OK200069200MOtherOK MEDICAID OSUFFS
KS200308850BMedicaid
KS200308850BMedicaid
OKDF6362Medicare PIN