Healthcare Provider Details

I. General information

NPI: 1316345531
Provider Name (Legal Business Name): SSM HEALTH CARE OF OKLAHOMA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 N SANTA FE AVE SUITE 1010
OKLAHOMA CITY OK
73118-7538
US

IV. Provider business mailing address

6201 N SANTA FE AVE SUITE 1010
OKLAHOMA CITY OK
73118-7538
US

V. Phone/Fax

Practice location:
  • Phone: 405-772-8687
  • Fax: 405-772-8688
Mailing address:
  • Phone: 405-772-8687
  • Fax: 405-772-8688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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