Provider Demographics
NPI:1942201397
Name:INTEGRIS BASS BAPTIST HEALTH CENTER
Entity Type:Organization
Organization Name:INTEGRIS BASS BAPTIST HEALTH CENTER
Other - Org Name:INTEGRIS CALDWELL FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT & COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-949-3402
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:405-713-5515
Mailing Address - Fax:405-713-5532
Practice Address - Street 1:415 S OSAGE ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:KS
Practice Address - Zip Code:67022-1650
Practice Address - Country:US
Practice Address - Phone:620-845-2516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100755850BOtherOK MEDICAID FFS
KS100100440 COtherKS MEDICAID RHC
OK100193490EOtherOK MEDICAID SC
OK100699500POtherOK MEDICAID RHC
OK100699500PMedicaid
KS100100440 DOtherKS MEDICAID FFS
KS460169OtherKS RHC CHILD MERCY
KS100100440 DOtherKS MEDICAID FFS
KS178973Medicare Oscar/Certification
KSCQ2516Medicare PIN