Provider Demographics
NPI:1699865493
Name:INTEGRIS BAPTIST REGIONAL HEALTH CENTER
Entity type:Organization
Organization Name:INTEGRIS BAPTIST REGIONAL HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-542-6611
Mailing Address - Street 1:129 N KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-4211
Mailing Address - Country:US
Mailing Address - Phone:918-825-1600
Mailing Address - Fax:918-542-1555
Practice Address - Street 1:129 N KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4211
Practice Address - Country:US
Practice Address - Phone:918-542-5551
Practice Address - Fax:918-542-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4754060003Medicare NSC