Healthcare Provider Details

I. General information

NPI: 1639689375
Provider Name (Legal Business Name): SSM HEALTH CARE OF OKLAHOMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH ST STE 1100
OKLAHOMA CITY OK
73102-1015
US

IV. Provider business mailing address

608 NW 9TH ST STE 1100
OKLAHOMA CITY OK
73102-1015
US

V. Phone/Fax

Practice location:
  • Phone: 405-231-3000
  • Fax: 405-231-3073
Mailing address:
  • Phone: 405-231-3000
  • Fax: 405-231-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateOK

VIII. Authorized Official

Name: CRYSTAL L PENA
Title or Position: INSURACE CREDENTIALING SPECIALIST
Credential:
Phone: 405-272-7452