Organization
INTEGRIS BASS BAPTIST HEALTH CENTER
Active
Other names
INTEGRIS HEALTH MEDICAL GROUP WAYNOKA
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA WALLACE (ASSISTANT TREASURER)
(636) 359-4890
Entity
Organization
Contact information
Practice address
1084 NICKERSON ST, WAYNOKA, OK 73860-1245
(580) 824-2281
Mailing address
PO BOX 200731, DALLAS, TX 75320-0731
(405) 252-8400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100699500K
—
OK
05
—
100755790C
—
OK
Enumeration date
08/10/2005
Last updated
04/07/2025
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