Provider Demographics
NPI:1922748086
Name:INTEGRIS AMBULATORY CARE CORPORATION
Entity Type:Organization
Organization Name:INTEGRIS AMBULATORY CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-951-2737
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:405-945-4500
Mailing Address - Fax:
Practice Address - Street 1:3400 N MUELLER AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3950
Practice Address - Country:US
Practice Address - Phone:405-945-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100736700AMedicaid