Healthcare Provider Details

I. General information

NPI: 1871012955
Provider Name (Legal Business Name): SSM HEALTH CARE OF OKLAHOMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 S DOUGLAS BLVD STE 305
OKLAHOMA CITY OK
73150-1018
US

IV. Provider business mailing address

3400 S DOUGLAS BLVD STE 305
OKLAHOMA CITY OK
73150-1018
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-2870
  • Fax:
Mailing address:
  • Phone: 405-272-2870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateOK

VIII. Authorized Official

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