Provider Demographics
NPI:1811932155
Name:INTEGRIS PROHEALTH URGENT CARE
Entity type:Organization
Organization Name:INTEGRIS PROHEALTH URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUPFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-949-3011
Mailing Address - Street 1:700 24TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6232
Mailing Address - Country:US
Mailing Address - Phone:405-364-0555
Mailing Address - Fax:405-573-5477
Practice Address - Street 1:700 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6232
Practice Address - Country:US
Practice Address - Phone:405-364-0555
Practice Address - Fax:405-573-5477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherTAX ID