Provider Demographics
NPI:1831142967
Name:BAPTIST CARDIOLOGY SPECIALISTS
Entity Type:Organization
Organization Name:BAPTIST CARDIOLOGY SPECIALISTS
Other - Org Name:INTEGRID BAPTIST MEDICAL CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-951-4360
Mailing Address - Street 1:DEPT 96-0372
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0372
Mailing Address - Country:US
Mailing Address - Phone:405-951-4360
Mailing Address - Fax:405-951-4359
Practice Address - Street 1:3433 NW 56TH ST
Practice Address - Street 2:400
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4455
Practice Address - Country:US
Practice Address - Phone:405-951-4360
Practice Address - Fax:405-951-4359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200121670AMedicaid
OK300522238Medicare PIN