# BAPTIST HEALTHCARE OF OKLAHOMA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** INTEGRIS Mayes County Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881659746
- **Authorized official:** MR. DOUGLAS KENT WEAVER (PRESIDENT)
- **Authorized official phone:** (918) 825-1600

## Contact information

- **Practice address:** 1301 NE 1ST ST, PRYOR, OK 74361-8850
- **Practice address phone:** (918) 824-7777
- **Practice address fax:** (918) 824-6414
- **Mailing address:** 1301 NE 1ST ST, PRYOR, OK 74361-8850
- **Mailing address phone:** (918) 824-7777
- **Mailing address fax:** (918) 824-6414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 04/20/2006
- **Last updated:** 03/31/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200039950A | — | OK |
| 01 | — | 37D1030240 | CLIA | OK |