Healthcare Provider Details

I. General information

NPI: 1295493955
Provider Name (Legal Business Name): SSM HEALTH CARE OF OKLAHOMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 PARKLAWN DR
MIDWEST CITY OK
73110-4201
US

IV. Provider business mailing address

7106 SOLUTIONS CTR
CHICAGO IL
60677-7001
US

V. Phone/Fax

Practice location:
  • Phone: 405-610-4411
  • Fax:
Mailing address:
  • Phone: 855-989-6789
  • Fax: 314-344-7281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL L PENA
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 405-272-7452