Provider Demographics
NPI:1306190327
Name:INTEGRATED COMPREHENSIVE HEALTH CARE
Entity Type:Organization
Organization Name:INTEGRATED COMPREHENSIVE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:HANSARD
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:405-843-7300
Mailing Address - Street 1:4801 N CLASSEN BLVD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4627
Mailing Address - Country:US
Mailing Address - Phone:405-843-7300
Mailing Address - Fax:
Practice Address - Street 1:4801 N CLASSEN BLVD
Practice Address - Street 2:SUITE 122
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4627
Practice Address - Country:US
Practice Address - Phone:405-843-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200406740A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200406740AMedicaid