Organization
INTEGRIS RURAL HEALTH INC
Active
Other names
Integris Canadian Valley Family Care Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY M BROWN (VP OF PHYSICIAN PRACTICE MANAGEMENT)
(580) 548-1367
Entity
Organization
Contact information
Practice address
1468 N MUSTANG RD, MUSTANG, OK 73064-0000
(405) 376-1800
(405) 376-1856
Mailing address
PO BOX 960033, OKLAHOMA CITY, OK 73196-0033
(580) 548-1367
(580) 548-1583
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200014470B
—
OK
01
—
200014470C
MEDICAID SC
OK
05
—
200014470D
—
OK
Enumeration date
08/10/2005
Last updated
01/02/2012
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