Provider Demographics
NPI:1528060019
Name:INTEGRIS BASS BAPTIST HEALTH CENTER
Entity type:Organization
Organization Name:INTEGRIS BASS BAPTIST HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-977-1831
Mailing Address - Street 1:PO BOX 5038
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-5038
Mailing Address - Country:US
Mailing Address - Phone:580-548-1367
Mailing Address - Fax:580-548-1537
Practice Address - Street 1:316 MAIN ST
Practice Address - Street 2:PO BX 659
Practice Address - City:GARBER
Practice Address - State:OK
Practice Address - Zip Code:73738-0659
Practice Address - Country:US
Practice Address - Phone:580-863-2204
Practice Address - Fax:580-863-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699500OMedicaid
OK100699500ZOtherOK MEDICAID SC
OK100755850AOtherOK MEDICAID FFS
OK100699500OMedicaid
OK373874Medicare Oscar/Certification
OK=========-005OtherBCBS OF OKLAHOMA