Healthcare Provider Details

I. General information

NPI: 1801346887
Provider Name (Legal Business Name): ST ANTHONY PHYSICIANS SANTA FE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 N SANTA FE AVE SUITE 2020
OKLAHOMA CITY OK
73118-7538
US

IV. Provider business mailing address

6201 N SANTA FE AVE SUITE 2020
OKLAHOMA CITY OK
73118-7538
US

V. Phone/Fax

Practice location:
  • Phone: 405-772-4450
  • Fax: 405-772-4459
Mailing address:
  • Phone: 405-772-4450
  • Fax: 405-772-4459

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