Provider Demographics
NPI:1023845179
Name:INTEGRIS AMBULATORY CARE CORPORATION
Entity type:Organization
Organization Name:INTEGRIS AMBULATORY CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-359-4890
Mailing Address - Street 1:PO BOX 843754
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3754
Mailing Address - Country:US
Mailing Address - Phone:405-252-8400
Mailing Address - Fax:
Practice Address - Street 1:13660 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-7004
Practice Address - Country:US
Practice Address - Phone:405-252-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRIS AMBULATORY CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-13
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation