Provider Demographics
NPI:1457372625
Name:INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION
Other - Org Name:INTEGRIS SOUTHWEST MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
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
Mailing Address - Street 2:100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4401 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3413
Practice Address - Country:US
Practice Address - Phone:405-636-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2289282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700200AMedicaid
OK100700200BMedicaid
OK370106Medicare Oscar/Certification