Provider Demographics
NPI:1326040817
Name:BASS MEMORIAL BAPTIST HOSPITAL
Entity Type:Organization
Organization Name:BASS MEMORIAL BAPTIST HOSPITAL
Other - Org Name:INTEGRIS BASS BAPTIST HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT RURAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:KALMANJE
Authorized Official - Last Name:WEINMEISTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:405-951-2616
Mailing Address - Street 1:PO BOX 960061
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0001
Mailing Address - Country:US
Mailing Address - Phone:580-548-1367
Mailing Address - Fax:580-548-1537
Practice Address - Street 1:221 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:OK
Practice Address - Zip Code:73728-2029
Practice Address - Country:US
Practice Address - Phone:580-596-3516
Practice Address - Fax:580-596-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1006995000Medicaid