Organization
INTEGRIS RURAL HEALTH INC
Active
Other names
Hennessey Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE C LAWRENCE (PRESIDENT & CEO)
(580) 548-1367
Entity
Organization
Contact information
Practice address
300 N CHEROKEE ST, HENNESSEY, OK 73742-1106
(405) 853-7171
(405) 853-6662
Mailing address
PO BOX 960183, OKLAHOMA CITY, OK 73196-0183
(580) 548-1367
(580) 548-1583
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200034700A
—
OK
01
—
200069200M
OK MEDICAID OSUFFS
OK
01
—
200069200Y
OK MEDICAID OSUSC
OK
Enumeration date
08/10/2005
Last updated
01/20/2011
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