Provider Demographics
NPI:1134163900
Name:INTEGRIS BAPTIST MEDICAL CENTER
Entity type:Organization
Organization Name:INTEGRIS BAPTIST MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-945-0045
Mailing Address - Street 1:PO BOX 960217
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0001
Mailing Address - Country:US
Mailing Address - Phone:405-947-8586
Mailing Address - Fax:405-948-6507
Practice Address - Street 1:3525 NW 56TH ST
Practice Address - Street 2:C100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4550
Practice Address - Country:US
Practice Address - Phone:405-945-0045
Practice Address - Fax:405-948-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========037OtherHUMANA TRICARE
OK=========016OtherBCBS OF OK
OK=========Medicare ID - Type Unspecified