Healthcare Provider Details

I. General information

NPI: 1114430022
Provider Name (Legal Business Name): SSM HEALTH CARE OF OKLAHOMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 NW 56TH ST STE 100D
OKLAHOMA CITY OK
73112-4549
US

IV. Provider business mailing address

3525 NW 56TH ST STE 100D
OKLAHOMA CITY OK
73112-4549
US

V. Phone/Fax

Practice location:
  • Phone: 405-942-4000
  • Fax: 405-942-9204
Mailing address:
  • Phone: 405-942-4000
  • Fax: 405-942-9204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateOK

VIII. Authorized Official

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