Provider Demographics
NPI:1497347934
Name:INTEGRIS DDSI ENDOSCOPY CENTERS LLC
Entity Type:Organization
Organization Name:INTEGRIS DDSI ENDOSCOPY CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-951-2757
Mailing Address - Street 1:5400 N INDEPENDENCE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5300
Mailing Address - Country:US
Mailing Address - Phone:405-713-5506
Mailing Address - Fax:
Practice Address - Street 1:3366 NW EXPRESSWAY STE 400
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4416
Practice Address - Country:US
Practice Address - Phone:405-702-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical