Organization
INTEGRIS BLACKWELL REGIONAL HOSPITAL
Active
Other names
Anesthesia Services of Blackwell
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY M BROWN (VP REGIONAL PHY PRACT MGMT)
(580) 548-1367
Entity
Organization
Contact information
Practice address
710 S 13TH ST, BLACKWELL, OK 74631-3700
(580) 363-2311
(580) 363-9463
Mailing address
PO BOX 960381, OKLAHOMA CITY, OK 73196-0381
(580) 548-1367
(580) 548-1583
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
PENDING
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100700340D
—
OK
Enumeration date
06/24/2009
Last updated
04/13/2011
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