Provider Demographics
NPI:1619152659
Name:INTEGRIS BAPTIST MEDICAL CENTER
Entity Type:Organization
Organization Name:INTEGRIS BAPTIST MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:HUPFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-949-3011
Mailing Address - Street 1:5100 N BROOKLINE AVE
Mailing Address - Street 2:950
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3623
Mailing Address - Country:US
Mailing Address - Phone:405-717-9800
Mailing Address - Fax:
Practice Address - Street 1:5100 N BROOKLINE AVE
Practice Address - Street 2:950
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3623
Practice Address - Country:US
Practice Address - Phone:405-717-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========Medicare PIN