Provider Demographics
NPI:1245231307
Name:INTEGRIS RURAL HEALTH INC
Entity Type:Organization
Organization Name:INTEGRIS RURAL HEALTH INC
Other - Org Name:INTEGRIS CANADIAN VALLEY OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEYERS
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 1:1205 HEALTH CENTER PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6396
Practice Address - Country:US
Practice Address - Phone:405-717-7820
Practice Address - Fax:405-350-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200035150AMedicaid
OK=========-001OtherBCBS OF OKLAHOMA
OK200035150AMedicaid
OKDD7159Medicare PIN