Provider Demographics
NPI:1396216677
Name:INTEGRIS BASS BAPTIST HEALTH CENTER
Entity Type:Organization
Organization Name:INTEGRIS BASS BAPTIST HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-949-3774
Mailing Address - Street 1:PO BOX 269032
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9032
Mailing Address - Country:US
Mailing Address - Phone:405-252-8400
Mailing Address - Fax:405-713-4322
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:580-977-1960
Practice Address - Fax:580-977-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care