Provider Demographics
NPI:1407860190
Name:BAPTIST HEALTHCARE OF OKLAHOMA, LLC
Entity Type:Organization
Organization Name:BAPTIST HEALTHCARE OF OKLAHOMA, LLC
Other - Org Name:INTEGRIS HOME CARE NORTHEAST
Other - Org Type:Doing Business As
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 960399
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0399
Mailing Address - Country:US
Mailing Address - Phone:918-786-4461
Mailing Address - Fax:918-787-3645
Practice Address - Street 1:1103 E 13TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-7928
Practice Address - Country:US
Practice Address - Phone:918-786-4461
Practice Address - Fax:918-787-3645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7012251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699700EMedicaid
OK100699700EMedicaid